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UNITED STATES OF AMERICA. 



NOTES 



Visiting Nurses 



AND ALL THOSE INTERESTED IN THE WORKING AND 

ORGANIZATION OF DISTRICT, VISITING, OR 

PAROCHIAL NURSE SOCIETIES. 



ROSALIND GILLETTE SHAWE, 

DISTRICT NURSE FOR THE BROOKLYN RED CROSS SOCIETY. 



WITH AN APPENDIX, 

EXPLAINING THE ORGANIZATION AND WORKING OF VARIOUS VISITING AND 
DISTRICT. NURSE SOCIETIES, 

B,Y MRS. HELEN C. JENKS. 



PHILADELPHIA: ^^J{ / ' 

P. BLAKISTON, SON & CO., 

IOI2 WALNUT STREET. 
1893. 



^X'^ 



1 



55 



Copyright, 1893, by P. Blakiston, Son & Co. 



Press of Wm. F. Fell & Oo , 

1220-24 Sansom St., 

philadelphia. 



PREFACE. 



In presenting this work to the public, the writer 
feels thaf possibly she may interest her readers in 
a branch of nursing which has by no means been 
fully canvassed. 

Work amongst the poor always assumes more 
or less of a philanthropic character, and appeals to 
the sympathies of the warm hearted, or arouses 
the thought of the social economist as to why and 
wherefore so much energy is needed: and work 
amongst the sick poor has especial need for con- 
sideration ; for sickness is one of the accidents in 
life against which prudence and thrift do not 
always ensure their most ardent votaries ; and 
which calls for all the graces humanity can muster 
to deal with efficiently. To be sick is an evil, all 
will admit; to be sick and sunk in the depths of 
poverty as well, so that httle can be done to miti- 
gate the sufferings attendant upon illness, is an 
aggravated form of the evil. 

To lessen the miseries of the very poor when 
iii 



IV PREFACE. 

ill, or to prevent them from ignorantly contracting 
disease themselves and disseminating it amongst 
others, by timely cautions and hints, is the voca- 
tion of the District Nurse. 

Wisely carried out her mission is an arduous 
undertaking, and to keep her from discouragement 
she needs the support and the sympathy of the 
well-to-do public. 

These few facts are compiled in the hope that 
they may prove useful to some who may be glad 
to cull a hint from actual experience, to help them 
possibly in a new undertaking. 

And also with the desire that they may prove 
interesting to those who would willingly uphold 
the hands of the workers did they but understand 
what the work really is. 

The truth as illustrated in the parable of the 
Good Samaritan has percolated down through the 
ages, and reaching us has a very pertinent signifi- 
cance as regards the neighborliness of life in all of 
our large cities. We cannot shut our eyes to the 
exigencies of the situation if we would. 

The writer is deeply indebted to Mrs. Helen C. 
Jenks, for her kindly interest in this effort to set 
forth District Nursing, as is evidenced in the appen- 
dix, which shows something of the work that has 
been done, and gives practical hints for those con- 
templating starting the work in other places ; her 



PREFACE. V 

position on the board of the Philadelphia Visit- 
ing Nurse Society and her prominence in other 
philanthropic enterprises, rendering her an authority 
upon the subject. 

R. G. Shawe. 

April ist, i8gS' 



LIST OF CONTENTS. 



PAGE 

Preface, v 

Introduction, 9 

The Conditions to be Met, 18 

Methods of Work, 25 

How not to Pauperize the Poor, 30 

Outfit and Personal SuppUes of the District Nurse, 35 

General Supplies of the District Nurse, 45 

Emergency Cases and their Treatment, 49 

Surgical Nursing, 61 

Sick Children, 66 

Infectious and Contagious Diseases, 80 

Medical Nursing, SS 

Fever Nursing, 93 

Obstetrical Nursing, loi 

Teaching in the Homes, 104 

Cookery for the Sick Poor, , . . 109 

Appendix, 117 

Index, 141 



Vll 



Notes for Visiting Nurses. 



CHAPTER I. 



INTR OD UCTOR V. 

A District Nurse who has her locality well in 
hand knows of and stands ready to relieve any 
case of distress in her neighborhood which arises 
from sickness and poverty combined. This, together 
with teaching the laws of hygiene to the ignorant 
poor, we think is her work. 

The District Nurse is first of all a nurse, just as a 
physician is a physician, whatever branch of service 
he may select, although nurses are not yet hedged 
about by legal protection in the pursuance of their 
profession, and there are nurses of every grade of 
capacity, both trained and untrained, who may 
compete in the carrying on of every branch of 
the work. 

The woman who expects to be successful as a 
District Nurse must thoroughly understand nursing, 
by whatever method she may practically have 

9 



lO DISTRICT NURSING. 

acquired her knowledge. And societies do well 
to secure the services of the best nurses for district 
work : by best nurses we mean those of the best 
education, general and special, of the widest ex- 
perience in life, capable of reading human nature, 
tactful, enduring, and of proven experience in other 
departments of nursing. This point of having the 
best nurses for district work is of moment to the 
community at large, for the rich and the poor 
dwell very nearly together — the health of the one 
class affecting the well being of the other, so that 
in times of epidemic none feel safe. The spread of 
contagion is oftentimes through subtle channels, 
and the person who deals with the ailments of 
the poor more often protects the rich than perhaps 
the rich know of. 

An attack of scarlet fever or measles or 
diphtheria can be contracted in all sorts of unlooked- 
for places ; and many a home mourns the untimely 
dead, whose lives have paid the penalty for others' 
sins and ignorance. 

Understanding nursing in general, a District 
Nurse should have the further training in special 
work which can be obtained chiefly in practical 
service, aided by the written experience of others. 
In our opinion, novices who desire to enter this 
work would do well to put themselves in training 
for a time under a working District Nurse. 



INTRODUCTORY. I I 

By natural gift, some nurses are better fitted for 
work amongst the very poor than others. Any 
nurse who thinks of taking up this branch of the 
work had best weigh well her reasons for so doing, 
and bear in mind that the office is not one for self- " 
indulgent ease. A thoroughly competent District 
Nurse works, and works hard. In times of especial 
epidemic she works through long hours. During 
the healthiest season she has much to do in teach- 
ing hygienic laws to the ignorant, if not constantly 
occupied in actual bedside nursing. 

She should have sympathy for sorrow and suffer- 
ing without the slightest taint of maudlin senti- 
mentality in her composition, for the people she 
deals with are usually those who require the moral 
support of a positive nature to aid them ; their very 
poverty makes them helpless, and tends to further 
pauperize them, unless there is brought to bear upon 
them a strong influence to compel them to the 
utmost self-help in their power. 

She must constantly be dragging up those who 
have fallen into a slough of despondency, and no 
woman can do this work effectively and well, who 
has not a kind heart combined with a hard head, 
and who has not at the same time a great love for 
humanity. Any one may theoretically love little 
children ; to love little children who are sick, dirty, 
and unwholesome, and possibly covered with sores 



12 DISTRICT NURSING. 

and vermin, to clean these same little children with 
her own hands, and to perform the same ofifices for 
children of a larger growth, the sick, ignorant, dirty 
adults, who have never properly learned the uses of 
soap and water, needs a person with a love for 
humanity amounting almost to a reverence. 

But there are nurses who stand ready and willing 
to do just this work. And they look to the more 
fortunate public to aid them in their labors with 
moral and material support. Sickness is hard to 
bear under the most favorable conditions. It is 
doubly hard to endure in the cramped homes 
of the very poor, where there is no money to buy 
necessities. • 

To make the best of untoward conditions, and to 
create comfort where none exists, and from the 
scantiest of materials, is an art the nurse acquires 
by degrees ; it scarcely comes natural to any 
woman, although there are some who can do with 
far less than others. 

The District Nurse has need to learn to make 
the very most of her poor and meagre supplies. 
She values life as life, and seeks to save it and to 
make it more abounding. Health and strength are 
to the very poor their chief capital, and she realizes 
this and seeks by every means in her power to 
preserve and to conserve their working force. If 
incurable disease is upon any she can do much 



INTRODUCTORY. 1 3 

to smooth the way through the later stages of a 
weary hfe. 

Being, however, only a nurse, she learns to work 
with other organizations for the relief of other 
misery than that caused solely by disease. Her- 
peculiar province being caring for the sick, and 
teaching the poor how to keep well, she must fre- 
quently depend upon others to remove the causes 
which produce and aggravate illness. 

In these days of complex social conditions the 
suppression of extreme poverty and the long list 
of distresses which follow in its train can only be 
done by the united efforts of many philanthropists. 
Perhaps there is no person who so fully under- 
stands the difficulties of dealing wisely with the 
very poor as a District Nurse. She enters their 
homes in the times of the greatest distress. She 
learns the depths of their misery as none other can, 
and she sees how ver)^ easy it is for the mentally 
weak and morally shiftless amongst them to lean 
for support upon any who will assume the burden 
thereof She learns how little gratitude is often- 
times shown for benefits received as gifts. And she 
also knows that jewels of mental and moral Vvorth 
are found in the most unexpected places. 

Her work lies in the worst of hygienic surround- 
ings, for in mean, dirty sections are found the 



14 DISTRICT NURSING. 

dwellings of the very poor. To create cleanliness 
and an air of thrift in habitations filthy in them- 
selves and rickety in the extreme is a task similar 
to that of making bricks without straw ; and yet 
the District Nurse does contrive to make waste 
places glad, her kind deeds being the open sesame 
to brighter lives in very dark homes indeed, and 
her ministrations doing much toward alleviating the 
worst forms of suffering. She brings the power of 
knowledge to offset ignorance in dealing with sick 
bodies, and with untiring energy combats despond- 
ency of mind in those physically afflicted. 

Not that all of her patients need necessarily be 
under a mental cloud, but too many are so, as all 
physicians who practice amongst the very poor 
know. Poverty is in itself depressing, and when 
combined with bodily disease is apt to darken the 
outlook for the invalid. Such being the case, it is 
apparent that none but an exceedingly cheerful, 
sunny-hearted person is fit to work amongst the 
very poor. 

Again, the effect upon the nurse of constantly 
looking at misery and suffering, unless offset by 
some mental recreation during some part of each 
day, is excessively wearing ; the weariness of both 
body and mind which is induced by the work is 
^far greater than any who do not know something 



INTRODUCTORY. 1 5 

of what sickness is and who can realize the de- 
pressing influence of extreme poverty can well 
understand. 

No nurse, any more than a doctor, can afford to 
become case hardened. Her most effective power . 
lies in her sympathy, guided by knowledge. With- 
out this sympathy by far the larger part of the work 
of a District Nurse would be quite useless. Many of 
the poor will suffer long and endure much before 
they will accept a grudgingly bestowed or half- 
hearted assistance. There are souls so debased as 
to fawn upon the unwilling rich, but a large num- 
ber of the sick poor are keenly observant of the 
spirit which actuates the ministration to their neces- 
sities. To feel kindly, to act with prudence, and as 
unselfishly as circumstances will permit, seems to 
us the imperative duty of the District Nurse. She 
should look for the best in people and not distrust 
either their gratitude or their good principles with- 
out positive proof that both are lacking. Her merci- 
ful services should rather be rendered in the spirit 
of a disinterested regard for their best good. 

In the carrying out of her work in this manner there 
is a constant drain upon her sympathies, her time, 
her strength, and her energies; and this wear and tear 
must eventually tell upon the strongest woman. A 
nurse who is wise will find suitable recreation 
during some part of each day to take her mind 



l6 DISTRICT NURSING. 

wholly off from the work in hand. This we think 
the true secret of being fresh for the work of each 
new day, and of being able to hold out in the pur- 
suit of one of the most arduous of all callings. 

As any specific rules as to the conduct of the 
District Nurse upon all occasions might savor a 
little of an endeavor to the fitting to a David of a 
Saul's armor, it seems best that those who attempt 
the work should study their own strong points, as 
well as learn their own weaknesses. A trial of a 
few months' time will soon convince any woman 
as to her peculiar fitness for the work; as to 
whether she has the physical endurance requisite 
for the exertions she is called upon to make, if 
she can bear the long walks, the needful exposure 
to all weathers, and has the power to resist the in- 
breathing of foul stenches in summer, and damp 
confined atmospheres in winter ; whether she does 
not revolt at filth and dirt and vermin, combined 
oftentimes with disease in its worst forms ; 
whether she has the carefulness to protect herself 
in caring for infectious and contagious diseases ; 
whether she has the tact to make friends of all 
sorts and conditions of men, women, and children, 
or if she have the gift of plain speech which flies 
straight home without unduly wounding sensibili- 
ties ; whether she have the gift of humor which 
drags the foibles of her patients forth, and turns 



INTRODUCTORY. 1/ 

the laugh upon them, and compels the mending of 
their faults whether they will or no. All this, and 
much more, a District Nurse learns about herself 
by experience. 

As nothing succeeds like success, the District 
Nurse who finds her patients recovering in health, 
and seeking her out on all possible and impossible 
occasions, may conclude she is doing fairly good 
service. 

It is not a work in which any woman may be- 
come unduly puffed up ; for do all one can, there 
will be far more left undone than accomplished. A 
few lives saved to their families ; a small number 
preserved from hopeless invalidism ; another small 
number made comfortable in their dying hours, and 
the sufferings of others lessened ; — this is the sum 
of the work, and in a feeling that a few have been 
helped by her will lie the chief reward of her faith- 
ful labors. 



CHAPTER II. 



THE CONDITIONS TO BE MET. 

A District Nurse necessarily works in closely 
crowded localities. It is in the slums of the cities 
she finds her most promising fields of labor ; she 
has to deal with the tenement-house problem in its 
worst phases ; with poor drainage, bad ventilation, 
garbage, filth and dirt, lack of sunlight — in fact, 
with the worst conditions under which sickness can 
be met. 

She must work under difficulties which threaten 
to set all rules of training at defiance. She cannot 
always command the necessities, much less the 
conveniences, to work with. No model sick-rooms 
with the proper apparatus for nursing are found in 
the homes of the very poor. For every breath of 
pure air, for every gleam of sunshine, for such 
quietness for her patient as can be obtained under 
difficulties, she is grateful. She learns to prize the 
little, and to be thankful that matters are no worse. 
Very often the ignorant people she deals with can- 
not be reasoned into right living nor coaxed into 

i8 



THE CONDITIONS TO BE MET. I9 

proper measures for recovery, nor yet has she the 
support of hospital discipline to aid her in her work. 
She is oftentimes at her wits' end to know how to 
make any headway at all. How to meet the diffi- 
culties of the situation, and how to enforce the 
commands of the doctor, is a problem always under 
consideration, and never more than partially solved. 
She finds that she has entered upon a course of 
higher education, and the obstacles in the way of 
her progress make the pons asinorum of her school 
days seem but child's play in comparison. The 
evils she deals with are hydra-headed ; she cuts off 
one branch only to find a new one cropping up close 
at hand ; v/hatever difficulties can arise are sure to 
meet her at one turn or another to try her patience 
and to put her powers of expediency to the test. 
In one house she will find one thing to be righted, 
in another quite a different state of affairs, and yet 
possibly something equally discouraging to cope 
with. 

Amongst the perplexities of her work are those 
arising from the indifference of the people them- 
selves as to what is healthful and wholesome. Pain, 
the wise provision of Nature to signal when the 
running machinery is off the track, is sometimes 
endured with a stoicism worthy of a better cause, 
whilst the warning it gives is all unheeded. To be 
rid of the pain is esteemed a blessing, but the way 



20 DISTRICT NURSING. 

to prevent disease and so have no pain is neglected. 
This indifference is not always the result of 
ignorance, but it frequently is, and on occasions this 
ignorance may be very dense. She sometimes finds 
the people to be taught are, like the young wife of 
the Yorkshireman, '' rayther slow at tackin in," if 
they take in at all. 

Then there is the landlord and tenant question to 
be considered. Very few people, if any, who re- 
quire a District Nurse live in their own houses. 
Their abodes are rather rented apartments, or small 
houses. In a very large proportion of the families 
she visits, there is some lack of decency in the 
houses they live in. The stairs may be rickety, the 
hallways unclean, the closets not properly flushed, 
the drain-pipes poor, the woodwork more or less 
rotten, and the house in a generally poor sanitary 
condition ; there may be overcrowding of the in- 
mates, objectionable neighbors, and, in case of con- 
tagious disease, no means of isolation ; the question 
of payment of rent during the stress of illness is 
always a weighty matter, one of the woes the tales 
of which are poured into the ear of a sympathetic 
nurse. The landlords are possibly tentative, and 
do not care to have a third person interfering in 
their business matters, and it is only in dealing with 
most extreme and flagrant abuses the nurse can 
consideV she has a moral right to annoy them ; 



THE CONDITIONS TO BE MET. 21 

tenants may not take a proper interest in keeping 
the premises of others in order, and too frequently 
they cannot be roused into doing their duty. 

The legal measures for protecting the public 
health may seem fully adequate so far as the laws 
read ; in actual practice they may prove very unsatis- 
factory, not equal to the emergency, and slow and 
ponderous in action ; the truth may be difficult to 
arrive at, as people often conceal such matters as 
should be laid open, and evade inquiry, so that no 
legal basis can be found upon which to operate. 

Of all such matters as the number of cubic feet 
space necessary for the well being of each person, 
a good water-supply, a proper drainage, the removal 
of garbage, the cleanliness of the common hallways 
and the water closets, the law may take note pos- 
sibly, but the enforcing of its regulations is quite 
an important and too frequently a cumbersome 
matter. 

In the furnishing of the homes there may be 
tawdry finery, without either wholesomeness or 
taste, or there may be extreme want of decent 
belongings. 

As regards the patients themselves, too frequently 
they cannot rest during illness. They feel com- 
pelled to work, whether they are w^ell or ill, until 
they fairly drop in the harness ; oftentimes they 
cannot afford to buy proper food. If they remain 



22 DISTRICT NURSING. 

quiet bodily, there is always the mental anxiety of 
getting bread ; there is sometimes a total lack of 
comfortable bedding and household supplies, and 
no proper clothing, and almost always overcrowded 
rooms to live in. 

Medical attendance may be given, the nurse's 
services likewise given, yet, unless these are sup- 
plemented by the necessities of life, it would seem 
almost as if their services were a mockery ; to try 
to sustain life on nothing is a task the bravest can 
scarcely undertake with hopefulness. 

The nurse finds she cannot do her work single- 
handed and alone ; she turns from the misery on 
the one hand to the kindly-disposed on the other 
amongst the more favored ones, and begs the needed 
help to pass on. The work speaks for itself So 
long as there are charitable hearts to donate relief, 
and ignorant poor to suffer, so long must the work 
of the District Nurse be one which most closely 
appeals to the sympathies of the humane. 

There is one other condition wherein district 
nursing differs from other nursing, which it may 
be well to note, and that is the relation of the 
District Nurse to the physicians of the community. 

She meets not one physician only, but many. 
Sometimes her cases are sent her by physicians 
who have the patients in charge. Sometimes 
ladies who are interested in poor families ask for 



THE CONDITIONS TO BE MET. 23 

her services on their behalf. There may be a 
doctor in attendance or she may be left to supply 
one. The society employing her may regulate the 
matter of medical service. But, possibly, she 
may often be left to her own discretion as to what 
doctor she shall try to get interested in her case. 

Medical service is given freely to the sick poor. 
In our large cities none need ever die without attend- 
ance of a doctor, free of charge, if there is no 
money to pay for his advice. The nurse need not 
fail to find medical treatment for any who may ask 
this of her if she sets properly about it. She owes 
it to the profession that she find some suitable phy- 
sician for every case that needs attendance and 
comes under her jurisdiction, and that she faithfully 
carries out or insists on being carried out the orders 
of the doctor in charge of each patient, whether 
they meet with her private approval or not. It is 
her business to inspire her patient with confidence 
in the ability of the physician in attendance, not to 
criticise this doctor and that one ; the difficulties 
in her way are the choice of physicians, the getting 
the suitable physician for the case, the adapting 
herself to the methods of practice of varying phy- 
sicians, and the suppressing of any temptation to 
the practice of therapeutics on her own account. 
Amongst the doctors of a large city are those of 
varying shades of opinion ; to respect the conclu- 



24 DISTRICT NURSING. 

sions of each, and to have none of her own, is a 
position the nurse must take. 

Then there are difficulties in the way of teaching 
hygiene. To adapt the knowledge of a trained in- 
tellect to the comprehension of an untrained one 
is sometimes a well-nigh hopeless task, for the 
pupils add to a childish ignorance the thinking 
powers of an adult and a corresponding stupidity 
of apprehension, the most willing sometimes being 
very dull, and amongst all classes there is found 
superstition and a lack of openness to conviction. 



CHAPTER III. 



METHODS OF WORK. 

Plainly, the first thing to be done is to map out 
the district. Let the nurse have a fair idea of the 
ground she is to cover and of its general hygienic 
condition ; she should note the lay of the land, as it 
were, know whether certain spots are healthy or no, 
understand what diseases are rife in certain locali- 
ties and why, mark any nuisances to public health, 
and be able to cope with existing states of things 
in the most effective ways ; for example, if a certain 
cesspool has caused an outbreak of typhoid fever, 
have the cesspool drained rather than wear her 
strength away nursing case after case of the fever. 

There should be a constant appeal to legislation. 
Cities have their Boards of Health, and she should 
be indefatigable in ferreting out and calling the 
attention of the doctors in that district to such 
nuisances as may fall under their jurisdiction. Sun- 
light and pure air she should ever use as her m^ost 
efficient aids-de-camp in routing atmospheric mias- 
mas and in getting rid of foul odors. She ought 
3 25 



26 DISTRICT NURSING. 

to understand the uses of the best disinfectants and 
be provided with them. 

She should make herself known to all the doc- 
tors in her district, and be ever ready and will- 
ing to co-operate with them. Where the choice 
of a physician falls upon her, she should act impar- 
tially in her selection. If the patient expresses a 
wish to see a particular physician, she should secure 
his services if possible. She can in cases of neces- 
sity advise special treatment, and find the proper 
physician or surgeon to treat the case. 

She should also know the druggists of her dis- 
trict, and be known by them; they will usually co- 
operate with her quite willingly and oftentimes be 
of great service to her. 

There is in the minds of many of the very poor 
a strong prejudice against hospital treatment. In 
cases where such is obviously the best, she can 
sometimes by a little timely persuasion overcome 
the dislike, and get the patient transferred from an 
uncomfortable home to a hospital ward where the 
surroundings are preferable. 

From whatever starting-point the District Nurse 
works, she should be known amongst the people as 
the friend of the sick and the poor. This celebrity 
is gained soonest, perhaps, by an unselfish devo- 
tion to her work, yet she need not despise many of 
the tactful artifices by which she advertises her 



METHODS OF WORK. 2/ 

mission. The gospel of healing must be preached 
by going forth among the sick, not by waiting for 
the sick to come to you, for many never will come ; 
they must be sought out, and among these shy 
ones are the most needy and deserving patients of 
all. 

We think it well for her to keep regular office 
hours, in which the sick poor can come to her. 
She can advise many, see some who are not ill 
enough to be in bed, give out stores from her loan 
supply or as gifts, and take back such articles as 
have been loaned. A record of cases should be 
kept, and something of a history of cases written 
out. This is an aid to herself in future emer- 
gencies, or to her substitute if for any reason she be 
absent from the work ; it will generally prove an 
aid to the doctor in summing up his estimate of 
the case. The same families come cropping up 
again and again. With facts concerning them 
jotted down in regular order and easily accessible, 
the nurse can more readily manage them on sub- 
sequent applications than at first. 

The District Nurse should be familiar with the 
workings of all charitable and philanthropic enter- 
prises in her city. She can usually find the proper 
assistance in cases of need by so doing. She soon 
learns the strength of union in the forwarding of 
her work by utilizing the force of others. 



28 DISTRICT NURSING. 

Unless a district is small, the nurse finds she 
must select her cases, for a few patients well treated 
are more satisfactory than many just cursorily 
looked after ; and in the selection of cases there are 
a few points to be observed ; such as — 

Visit those who are most seriously ill, particu- 
larly the dying. 

Visit chronic cases to make them comfortable, 
prevent bed-sores, and cheer them. 

Work especially amongst little children and 
babies : it is better to teach mothers how to care 
for their children than to nurse them personally. 

It is imperative that contagious diseases be 
stamped out; be vigilant in treating such. 

Select those patients who are in the most ex- 
treme poverty. 

There are the peripatetic invalids, who go from 
doctor to doctor and from one dispensary to 
another. Their ailments may be real enough, but 
she soon learns what specialists in medicine or 
surgery can best do for them, and she usually can 
assist them to obtain the help they need, and so 
put an end to their wanderings. 

Any disease which is out of the usual course 
and of particular scientific interest to the medical 
profession is only too readily made capital of to 
draw upon the sympathies of the charitable by 
those who must be treated gratuitously; and here 



METHODS OF WORK. 29 

again the nurse finds she must frown severely upon 
the tendency to glorify diseases. 

In seasons of comparative neighborhood health- 
fulness the time of the nurse can be well employed 
in following up the lighter cases of illness amongst" 
the children, in teaching family hygiene and simple 
nutritious cookery, and in showing the mothers 
how to effectively clean off vermin from children 
and how to keep the children clean. 

We all understand that the surest passport to the 
confidence and the love of the poor lies in an unsel- 
fish and self-sacrificing spirit, and no one can less 
afford to be self-seeking than the District Nurse. 
And yet underlying her work must be a substratum 
of strong good sense. She must conserve her own 
force and not recklessly scatter her time, strength, 
and service upon incorrigible and comparatively 
worthless cases ; neither must she show partiality ; 
the world cannot be blessed or permanently bettered 
by such waste of energy. 

As the home is the unit of society, the nurse 
should show how to improve the home, and no 
person can better inculcate lessons of personal and 
household hygiene and teach habits of thrift than 
she can when she has the confidence of those whom 
she visits. In fact, her opportunities are boundless 
and her enthusiasm must be great to keep pace with 
the openings constantly arising before her. 



CHAPTER IV. 



HOW NOT TO PAUPERIZE THE POOR. 

Social and political economy are studies that are 
engaging the best thought of many wise men, and 
therefore we may be excused if we venture to sug- 
gest that the few ideas we present can by no means 
be considered as exhaustive ones. 

From a practical standpoint we recognize the 
fact that those who receive gifts, whether of service 
or material aid, readily learn to look for more, 
and are by so much the less willing to pay for such 
when needed again, even though the same need for 
gratuity may not exist. Hence the necessity of 
-keeping the poor up to a self-respecting and self- 
helpful standard. 

There is not a philanthropic enterprise which 
does not carry within itself the germ of moral evil 
which certain conditions will surely develop, but we 
do not fail to recognize the fact that we owe duties 
to our fellow mortals because in the exercise of 
these duties we blunder and fail to perfectly perform 
them. Sickness is a calamity which the rich are 

30 



HOW NOT TO PAUPERIZE THE POOR. 3 1 

not free from ; and, although their money can buy 
the best service to be had, such service is but too 
often ineffective. They go hence and leave behind 
them their accumulated possessions. The poor get 
sick and they cannot buy service. Sometimes they 
go hence not having suffered many things at the 
hands of physicians, but having borne only the 
kindly pangs of nature. Yet only too often nature 
is not beneficent in her dealings with sick mortals. 
Doctors can do much toward mitigating the evils 
they endure ; and, if life be spared, doctors are often 
the instruments of health giving. All that physi- 
cians and nurses can do for the rich and even more 
they can do for the very poor. To give service 
where there is no substance to pay for it seems 
but humane, and that doctors are as a class humane 
men none can deny, for probably no other body of 
men in the world give so much of personal service 
to their fellow-men as do they. 

It sometimes seems to us that the very poor are 
beginning to look for free medical service as a mat- 
ter of course. Between hospitals and dispensaries 
and all the other ways of obtaining free medical 
advice, they are educated up to suppose that sick- 
ness need not be looked forward to ; if it comes, 
the means of caring for the patient will be provided 
without cost. 

We think the very poor are provident when they 



32 DISTRICT NURSING. 

must be. Some of them will almost do without 
food to keep a small life-insurance policy paid for, 
for the undertakers will not open a grave without 
pay. It is far from us to criticise the religious beliefs 
of any, yet we have seen that the money paid to 
the church is saved even if doctors go without pay. 
In fact, the old adage,'^ where there's a will there's 
a way," is only too fully exemplified in the lives of 
the poor. 

But in some instances, and the District Nurse 
finds such, neither undertaker nor priest could find 
any pickings, nor is there food in the larder or 
comfort in the home. Some of our fellow beings 
are unfortunate to a degree which makes the 
neglect to minister to. their necessities morally a 
crime ; and in relieving their needs, it does not, 
we think, tend to increase their self-respect to fling 
alms to them without the touch of human sym- 
pathy. It is the medical profession and their 
coadjutors who unearth these helpless ones ; and 
it is oftentimes through them that temporary or 
even permanent relief must come. 

A District Nurse who is wise as well as kindly, 
recognizes how easily people who are partially 
disabled hy illness sink into helplessness and hope- 
lessness. It is her duty as well as her privilege to 
teach such to make the most of their little strength. 
How few in the ranks of life can boast of perfect 



HOW NOT TO PAUPERIZE THE POOR. 33 

health ! How many of us must go on to the end 
of our earthly careers more or less physically dis- 
abled ! The sick seldom realize this, much less the 
sick poor. They are too apt to think that they are 
afflicted above all others, when very probably they" 
may be really stronger than many a person who 
does not hesitate to render them some slight ser- 
vice toward alleviating their pain. 

To strengthen the things that remain is the 
blessed privilege of a nurse in any branch of her pro- 
fession. To help the poor to save life, and to make 
it more abounding, even in the face of woful dis- 
couragements, is the privilege of the District Nurse. 
To give ungrudgingly and kindly, expecting no 
return where it is self evident no return can possibly 
be made, is also her privilege. To look for some 
"compensation where there is ability and opportu- 
nity to render it is her prerogative, and to teach 
the utmost self-help her duty. 

She teaches the poor that sickness is an emer- 
gency in life liable to come to all, and only too 
apt to be a surprise ; and although she gives, she 
expects them to be willing to show an appreciation 
of her services on the return of health ; this keeps 
up their self-respect and induces them to make 
efforts in their own behalf. 

Laziness, drunkenness, disregard of the rights of 
little children who come into the world unwelcomed, 



34 DISTRICT NURSING. 

and improvidence, furnish work for the philan- 
thropic. When to all these is added sickness, the 
harvest is quite ripe for the labors of the District 
Nurse. In communities where all are sober, indus- 
trious, and self-respecting outside aid is seldom called 
for, unless by the way of neighborly kindness. It 
is the weaknesses and sins of humanity which make 
her work a necessity. As moral health is restored 
her labors lighten. 

In giving either her services or from her stores, 
or in obtaining help from others, therefore, she 
must constantly exercise judgment and common 
sense. When men will not work, they should not 
eat ; restore a sick man to health, put him on his 
feet, and command him to do for himself; this is the 
best way for a nurse to act in order not to pauper- 
ize the poor. 

So long as a patient is really ill, however, do not 
adopt half-measures. Let the nurse see that things 
are provided needful for doing her work in the best 
possible manner. A whole-hearted giving is in 
our way of thinking the best giving. To be ham- 
pered at every turn in trying to heal the sick is 
discouraging to the nurse and tends to keep the 
patient from a full recovery. 



CHAPTER V. 



THE OUTFIT AND PERSONAL SUPPLIES OF 
THE DISTRICT NURSE. 

Before entering into any discussion as to the ad- 
visability of distinctive habit, there are a few general 
rules which District Nurses may do well to con- 
sider. For both moral and sanitary reasons their 
dress should be simple and serviceable. Cleanliness 
of person, tidiness of appearance, smooth hair, and 
well-kept hands and nails, and well-shod feet 
should above all mark the District Nurse. The one 
who teaches cleanliness and orderliness should 
exemplify her teaching in her own person. This 
may seem a very easily accomplished matter to 
those who have not tried the w^ork and learned the 
difficulties in the way of carrying out the theory. 
To be clean, the nurse must bathe frequently ; to 
be fresh, she must sleep well, regularly, and long 
enough. Hands and nails require time to care for 
and keep in good condition, particularly while 
doing the rough work she must oftentimes do. 
Rain, wind, storm, and undue exposure to the ele- 

35 



36 DISTRICT NURSING. 

ments will set the most carefully made toilet awry. 
Besides, it is dreadfully hard to be thinking of one's 
own appearance when there is misery to be relieved, 
or some interesting case from a scientific standpoint 
to be considered. 

A woman who walks much learns how impossi- 
ble it is to walk with ease in a cheap shoe. The 
nurse's shoe bill is no inconsiderable item. And 
the laundry bill ! afresh dress for every occasion — 
for, undoubtedly, wash goods are the best for her 
wear. It is quite useless for a District Nurse to 
attempt to study economy in her own laundry 
work, however much she may try to save the wash- 
ing for her patients. 

She must be clean at any cost, or else find that 
the moral lesson of her " gospel of cleanliness " is 
quite lost. This may seem to be putting the 
matter a little strongly, but we fancy none too em- 
phatically. Plenty of clean dresses, broad shoes, 
easy to walk in, and a simple outward appearance, 
not altogether lacking in quiet style, is, we think, 
the ideal dress for a District Nurse. Any garb will 
not do, and it is a fallacy to suppose it will. 

As to the habit, one advantage of a distinctive 
garb lies in the protection it gives the wearer. 
Ignorant people reverence a habit with something 
of a religious awe. A woman can sometimes visit 
what are known as hard localities with more im- 



OUTFIT AND PERSONAL SUPPLIES. 3/ 

punity in a distinctive dress than she could without 
this aid. 

Another reason for its adoption is that by it she 
is known. The neighborhood get to know a Dis- 
trict Nurse very quickly if she be dressed in the 
garb of her order. 

Once adopted there is no change of style, and in 
a neat, becoming habit a nurse may feel quite at 
ease as to her outward appearance. When she 
leaves her work and puts on the ordinary dress of 
a lady, she leaves behind her all its associations, 
and by so much the more easily can she cast off the 
cares thereof, and effect a complete metamorphosis 
outwardly as well as inwardly. 

Our democratic feelings rebel, no doubt, at being 
known by our dress ; but reverence to superiors is 
dying out fast enough without our aiding and 
abetting its murder by a false pride of liking to 
adopt walking, shopping, or visiting costume while 
engaged in one of the most arduous of undertakings. 
We both teach a reverence for work and command 
a reverence to ourselves by being willing to adopt 
a distinctive dress in the pursuit of our calling. It 
need not be an ugly dress — far from it. But it 
should be the badge of our occupation. 

It is scarcely practicable to plan out a habit for 
others, yet a few general suggestions may not be 
unadvisable. Let all the clothing be both light and 



38 DISTRICT NURSING. 

loose, and worn from the shoulders. Heavy- 
weighted garments are not suitable for any woman 
who walks much, and uses her arms so constantly 
as does a nurse ; we think in texture the under- 
garments should suit the season, according to the 
thermometer running through the grades of heavy 
and light wool, gauze^ lisle thread, and linen. 
During the hottest weather, for example, when the 
work of the District Nurse is the heaviest, she can- 
not work efficiently in any but the lightest and 
thinnest of clothing. A nurse once called upon us 
on one of the hottest mornings of the season. She 
was anxious for some experience in the work, and 
came thinking to make the rounds that day. A 
short walk in the heat had completely exhausted 
her, and she seemed sweltering in the August 
atmosphere. She finally concluded that she should 
not be equal to the occasion on that day, but must 
wait for a cooler one before trying experiments. In 
dress she seemed extremely neat. She wore a 
gown of well-starched gingham, close fitting, fresh 
linen collar and cuffs; her whole outward look was 
as natty as one might desire. Judging from 
appearance, her corset was by no means worn 
loose, and we fancied that she had on an orthodox 
supply of undergarments. In such an attire we 
could not have worked on that day either. As it 
was, we were not uncomfortable. One plain linen 



OUTFIT AND PERSONAL SUPPLIES. 39 

undergarment made a good length, the thinnest of 
bleached, white, lisle thread stockings, thin, broad 
shoes, a linen bodice waist, and a linen lawn dress 
made to wear without collars and cuffs, the waist 
being a blouse and the skirt made with a" 
Spanish flounce, together with a shade hat, com- 
pleted our entire costume. 

And so on through the seasons, as the w^eather 
varies, the costumes may vary to suit, at least in 
underwear. For the outer dress in summer brown 
linen, trimmed with red braid, is quite pretty ; it 
makes a cool and serviceable dress ; if worn with 
suitable underwear it can be worn very late in 
the season. Alpaca is a serviceable material for 
winter wear and for stormy days. The shoe 
should always be broad, with either a low heel or 
a spring heel. 

Some trained nurses may prefer the distinctive 
dress of their own school ; others may have the 
dress worn by them chosen by the Society employ- 
ing them. 

A District Nurse should aim to keep her own 
health in as nearly a perfect condition as possible. 
She should sleep regularly, long enough, and keep 
regular hours as regards meals and general habits. 
As a rule. District Nurses do not go out at night. 
It would be better if they never did. A district of 
moderate size will give a nurse plenty of employ- 



40 DISTRICT NURSING. 

ment during the day for fifty weeks in the year, 
without encroaching on her night time. In times 
of special sickness her days may be lengthened 
from the ordinary service of eight or ten hours to 
twelve or even fourteen hours. In such seasons 
she must be more than ordinarily particular to get 
her regular sleep, and not neglect to eat at the 
proper times. If there is much night work needed, 
a special nurse should be detailed to meet the de- 
mand. There is no reason why all large cities 
should not have a sufficient corps of District Nurses 
to supply the need for them. 

A District Nurse should be in the habit of bath- 
ing daily in hot water; the best time for taking 
this hot bath is on going to bed. The entire per- 
son, including the hair, should be plunged in hot 
water, and quickly dried with soft towels ; the face 
can be steamed and massaged. If the nurse has 
been in the presence of contagious disease during 
the day the hair should be washed in a solution of 
bi-chloride of mercury 1-2000. 

In the morning a sponge bath in cold or tepid 
water is all-sufficient. The underclothing should 
be entirely fresh and clean each day, and dresses 
that show the least soilure discarded, if it takes a 
fresh one oftener than once a day to keep clean. 

The hands require special mention ; they must 
often do very dirty work. To keep them soft, 



OUTFIT AND PERSONAL SUPPLIES. 4 1 

white, and in good nursing trim requires great care ; 
gloves should be worn whenever practicable; 
always on the street, frequently when nursing. It 
is well to have a neat-fitting pair of rubber gloves 
for use in parts of the work ; and any number of 
pairs of old kid ones can be kept for ordinary use. 
The nurse should have a good steel nail file and 
use it night and morning. Very dry and brittle 
nails can be softened by a persistent use of vase- 
line. The hands should be frequently washed in 
hot water with soap, and rubbed with a little Indian 
meal, then dipped in a solution of bi-chloride of 
mercury i-iooo, the superfluous skin about the 
nails trimmed off, and the nails well brushed during 
the bath. Mutton tallow well rubbed in is perhaps 
the best ointment for chapped hands ; the sulphur- 
ous fumes from a burned match will oftentimes re- 
move stains. After handling any patient who has 
infectious or contagious disease, the nurse cannot 
be too careful to disinfect her hands. Clean she 
must keep them at all times ; doubly clean on such 
occasions. Odors can be removed from the hands 
by bathing them in a little mustard and water, 

A nurse should never under any consideration 
go into a room where there is a contagious or 
infectious disease hungry. In fact, always nurse 
with a full stomach, and when nursing contagious 
and infectious diseases visit no other patients. 
4 



42 DISTRICT NURSING. 

The personal supplies of the nurse are such ap- 
pliances as are needed in general nursing, and as 
any good nurse feels she must own, only perhaps 
greater iii number than for private work. If the 
nurse have but few to do with, she should not feel 
discouraged. Very good work can be done with 
but indifferent tools, and the lack of appliances 
should not deter her from doing her best. The 
things to work with will come in time to any nurse 
who patiently waits for them, and who improves 
her opportunities of getting them one at a time ; 
this refers both to personal and general supplies. 
The list given covers the ground fairly well : — 

A clinical thermometer. 

A water thermometer. 

A thermometer. 

A nurse's case of instruments. 

A hypodermic syringe. 

}^ dozen graduate measuring glasses. 

Blanks for sick-room memoranda. 

Note books and pencils. 

Stick of nitrate of silver in holder. 

Tablets of bi-chloride of mercury j^^ gr. each. 

Catheters. 

Camel-hair brushes. 

Soap and soft towels for private use. 

Vaseline. 

Mutton tallow melted with rose water. 



OUTFIT AND PERSONAL SUPPLIES. 43 

One dozen large white aprons. 

A pincushion. 

A small work bag fully equipped. 

A penknife. 

Sponges. 

And arranged in convenient form, tables con- 
taining the following information ; for, how^ever 
well a nurse may have learned these things, in the 
hurry of w^ork memory may prove treacherous, 
and it is well to have a small vade-mecum in the 
pocket : 

Abbreviations. 

The principal medicines and their doses. 

Poisons and their antidotes. 

Emergency hints. 

In addition, every nurse should have a small 
library of the best works on her profession to keep 
for ready reference. 

In this calling every nurse should grow, and if 
she be not more capable after some months of ser- 
vice than she was at the beginning of her career, 
she may well conclude that she has mistaken her 
calling. Nothing evinces her interest in her w^ork 
more than a desire to be well informed as to the 
history of the work and the methods of others. 

K x\.\xxs>^ 671 rapport \N\\h. her work likes to sur- 
round herself with such delicate reminders of the 



44 DISTRICT NURSING. 

lives of others who have lived in the work as shall 
stimulate her to like exertions. 

'* The Lady with the Lamp " is a personality to 
her, even though no authentic portrait is procurable. 

Among the best works we have seen we may 
mention the following: — 

A Century of Nursing. 

Notes on Nursing, by Florence Nightingale. 

Text-Book of Nursing, by Clara Weeks Shaw. 

Humphrey's Manual for Nurses. 

Handbook for Hospital Sisters, by Florence Lees. 

Obstetrical Nursing, by Anna M. FuUerton, m.d. 

Nursing in Abdominal Surgery, by Anna M. 
Fullerton, m.d. 

Canfield's Hygiene of the Sick-Room. 

Starr's Hygiene of the Nursery. 

The list may be extended to comprise quite a 
library of really excellent works. Then there are 
many ephemeral productions, pamphlets, papers, 
addresses, all good in their way and which fall into 
the hands of every nurse from time to time. 

And a nurse should be a subscriber to some 
good periodical which gives the fresh ideas of 
other nurses. 



CHAPTER VI. 



THE GENERAL SUPPLIES OF THE VISITING 
NURSE. 

By whomsoever employed, a District Nurse 
should have headquarters — a room, in a central 
locality if possible, where she can be found at a 
certain hour of each day ; where her supplies may 
be kept, where letters may be addressed to her, and 
where her day-books and other data concerning 
her work may be found, as her home should be 
' sacred to her, and not liable to be invaded. Societies 
who furnish a home for their nurses provide for her 
comfort during the hours when off duty. 

She should be in this room an hour or so each 
day, to look over letters, write up memoranda, 
select her supplies, and to receive any patients who 
call upon her. This room should be abundantly 
furnished with closets, and arranged upon the 
shelves should be her stores. These stores may 
be as varied as possible. If few in number, they 
can be added to from time to time, and no nurse or 
society should be discouraged because the supplies 

45 



46 DISTRICT NURSING. 

are low. An abundance is desirable, but much 
work can be done with little. 

However, no appliance ever used in a sick-room 
is out of place. If not needed in one sick-room, it 
very probably will be in another at some time when 
the want of it might prove a sore lack. To make 
this list of appliances as complete as possible should 
be the aim of the visiting nurse. A goodly num- 
ber of articles are enumerated ; the list may be ex- 
tended to a very lengthy one, or cut down to the 
absolute necessities by struggling societies : — 

Cot-beds, with mattresses, pillows, and bedding 
of all kinds, both new and old. 

Night wear for men, women, and children. 

Dressing gowns, bed slippers, and old stockings. 

Combs, and fine-tooth combs. 

Soaps and towels. Old linen. 

Mothers' bags. Old flannel. 

Bed rests. Oakum. 

Bed pans. Paper pads. 

Urinals. Absorbent cotton. 

Foot tubs. Cheese cloth. 

Hot-water bags. Tin basins. 

Ice bags. Catheters. 

Rubber rings. Syringes. 

Jackets, of oil silk. Breast pump. 

Oil silk. Atomizers. 

Old cotton. Towels. 



GENERAL SUPPLIES. 4/ 

A good, surgical tray, Cupping glasses. 

well furnished. Alcohol. 

Bandages. Ammonia. 

Medicine glasses. Whiskey. 

Medicine droppers. Brandy. 

Alcohol lamp." 

Old clothing, shoes, children's toys, and the like, 
need never be despised ; they can be made useful. 
Flowers and delicacies for the sick are always ac- 
ceptable ; and some way of getting needful food 
supplies for those w^ho are utterly destitute must be 
on call. Much of this stock maybe loaned out to 
be returned when the need for its use is past. For 
example, an easy chair will last for months in con- 
stant use from one patient to another. 

Lists may be tacked to the inside of closet doors. 
The amount in stock, the amount loaned out, and 
the names and addresses of the parties having 
stock in use. These lists may be altered as stores 
are given away, and fresh supplies brought in, or 
loaned articles returned. 

There should be a map of the city for ready re- 
ference, and a street directory ; also a list of charit- 
able institutions should be kept, and their latest 
reports, in order that their scope and method of 
relief may be thoroughly understood. 

The names, addresses, and office hours of all the 
doctors in the district should be known. 



48 DISTRICT NURSING. 

It is well also to keep such works as are obtain- 
able on philanthropic work, the simpler text-books 
on household hygiene, and plain talks with work- 
ing people can be on hand for ready reference. 
There are many such simple works which are 
thoroughly reliable, and embody scientific facts in 
popular form. 

The District Nurse may not be able to inaugurate 
courses of lectures on hygiene, but she should pre- 
pare the way for their reception, and in home teach- 
ing she has great need of the accumulated wisdom 
of many thinkers on these subjects. 



CHAPTER VII. 



EMERGENCY CASES AND THEIR 
TREATMENT. 

In our large cities the promptness of the 
ambulance service practically renders emergency 
nursing a minimum in the work of a District 
Nurse. 

Yet occasionally such may fall into her hands, 
and she should thoroughly understand what to do 
" until the doctor comes." 

• She has long since learned the anatomical struc- 
ture of the body, understands somewhat of the 
circulation of the blood, the elements of physi- 
ology, drugs and their actions, poisons and their 
antidotes, and knows the simpler methods of deal- 
ing ^yith fractures, dislocations, and sprains, with 
hemorrhages, and wounds, with ordinary syncope 
from emotions, with concussion and compression 
of the brain, convulsions, asphyxia, epilepsy, 
apoplexy, intoxication, hysteria, shock, drowning, 
sunstroke, burns, scalds, and frostbites, poisoning, 
with foreign substances in the orifices of the body, 

49 



50 DISTRICT NURSING. 

and can manage ordinary cases of midwifery with- 
out a doctor. 

The first thing for the District Nurse to do in 
case of any emergency, is to send the quickest ob- 
tainable messenger for a doctor, with information as 
to the nature of the accident, in order that he may 
come properly equipped. If the injury is of such 
a nature as to indicate hospital treatment an ambu- 
lance may be called for. 

If the patient must be moved from the scene of 
the accident an improvised stretcher can be made 
by fastening any smooth cloth over poles of suffi- 
cient strength to bear the weight of the patient. In 
most cases it is best not to move a patient until the 
doctor comes. 

If any of the bones of the body are fractured 
or dislocated the nurse should immediately put 
the parts at rest, making them immovable, and 
protecting them ; in some cases using impro- 
vised splints and bandages. If the fractures 
are compound some form of antiseptic dressing 
may be applied over the wound. The nurse 
need not attempt to reduce a fracture, for in a 
large city some surgeon can be obtained within 
a reasonable time. The injured part should be 
handled as little as possible, although the cloth- 
ing may be ripped or cut away. Almost any firm 
flat substance maybe used for an improvised splint, 



EMERGENCY CASES AND THEIR TREATMENT. 5 1 

thin wooden boards being the best, yet in a pinch 
pasteboard or stiffly folded papers, or any substance 
which will give firmness to the padding can be used ; 
and the padding may be any soft substance, easily 
procured — a pillow, folded clothing, hay, oakum, 
etc., and anything which can be used to hold the 
splint and padding in place, can be used for a 
bandage. In applying these improvised splints let 
the limb fall into as natural a position as possible, 
and put them on gently and smoothly ; not so 
tight as to cause any further pain to the patient. 
They should be long enough to extend some dis- 
tance above and below the injury, and generally 
include the near joints. 

In fracture of the cranial bones the patient 
should be laid on his back and kept perfectly quiet. 
Cold maybe applied to the head; ail stimulants 
must be ayoided, and the eyes should be shaded 
from the light. 

In fracture of the jaw bone shut the teeth firmly 
together and hold the jaw in place b}^ a four-tailed 
bandage. 

If the spine be injured let the patient lie in the 
posture most agreeable to him, with the face turned 
so as to breathe freely. Apply cold to the injured 
part. 

For fractured ribs apply a bandage snugly around 
the chest. 



52 DISTRICT NURSING. 

For a fractured clavicle lay the patient flat. 

If the shoulder-blade is fractured, place the arm 
of the affected side in a sling. 

„Fractures of the bones of the arms and legs are 
best bound in long splints. 

Dislocations are of the articulation of the bones, 
and usually the soft ligaments are more or less in- 
volved ; these should be as speedily reduced as 
convenient; that of the lower jaw is fortunately 
quite rare, but it is the one the nurse would be best 
justified in slipping into place, as any delay in getting 
this joint set is exceedingly painful to the patient; 
the nurse should wrap her thumbs in a soft cloth 
and place them upon the back teeth, pressing firmly 
downward and backward, meanwhile tilting the chin 
upward with the fingers ; this slips the jaw into place, 
and it is held there by the four-tailed bandage. 

Sprains are wrenchings or twistings of the joints. 
Hot fomentations should be applied at once, and 
the parts laid completely at rest. 

Contusions are most safely temporarily treated 
by hot fomentations, which help to alleviate the 
pain. 

Wounds are variously classified and as variously 
treated : the imperative need in an emergency case 
is to understand the kind of wound and to treat it 
accordingly. If it be from a poisonous bite suction 
should be applied to draw the poison out ; the juice 



EMERGENCY CASES AND THEIR TREATMENT. 53 

of plantain leaves, which is not officinal and is not 
kept in the drug stores, is good applied to these 
bites, especially those from snakes or spiders. 
Strong stimulants can be administered, such as 
muriate of ammonia in whiskey or brandy. 

For lacerated, incised, or punctured wounds where 
there is danger from hemorrhage, this should be 
arrested so far as practicable ; any wound should 
be examined, and foreign matter removed therefrom. 
A wound should be washed off by squeezing water 
over it with a clean sponge. An antiseptic solution 
may be used. 

Incised wounds may be temporarily brought 
together by strips of adhesive plaster; the injured 
parts sometimes need to be supported and pro- 
tected by compresses and bandages; the nurse will 
probably have some soft material she can use as a 
compress, such as linen, absorbent cotton, or anti- 
septic gauze, in her bag. 

A punctured wound can have a soothing applica- 
tion of some antiseptic lotion applied. 

In checking hemorrhages distinguish between 
arterial, venous, and capillary. 

An improvised tourniquet of a handkerchief 
twisted in place with a stick is oftentimes useful. 

If in any case of injury the nurse finds lockjaw 
approaching, she should instantly summon the 
nearest physician. 



54 DISTRICT NURSING. 

If artificial means must be used in arterial hemor- 
rhage, elevate the injured part, and if the flow be 
slight use pressure on the artery between the 
wound and the heart. Use the thumb or a com- 
press, and if possible press the artery against a bone ; 
in severe cases, and where practicable, if the wounds 
are situated so that digital pressure cannot be used, 
tampon the wound from the bottom up ; this 
method must be thoroughly applied, as poor tam- 
poning is worse than useless ; absorbent cotton is 
good for this purpose. 

In venous hemorrhage remove any ligature 
which may retard the flow of blood, and finding the 
suitable point beyond the injury from the heart, 
firmly compress the wound. Capillary hemorrhage 
may be checked by the application of either cold or 
hot water. 

For internal hemorrhage keep the patient quiet 
and cool, with the head elevated, and bandage the 
limbs to temporarily diminish the blood in circula- 
tion. 

Uterine hemorrhage may be controlled by hot 
uterine douches long continued (for one or two 
hours at least). 

In case of severe nose bleed, throw the head 
back, elevate the arms, and apply cold sponges to 
the back of the neck and over the bridge of the 
nose ; syringe the 'nasal cavity with cold salt and 



EMERGENCY CASES AND THEIR TREATMENT. 55 

water ; if nothing better is at hand drop a cold key 
down the back. 

In all cases of hemorrhage rest is essential to 
help form and retain the preventative clot. 

In concussion of the brain keep the patient quiet 
and apply cold cloths to the head. If the shock 
is great, use warmth for the extremities. In com- 
pression of the brain, keep the patient very quiet, 
apply cold compresses, and avoid stimulants. 

In dealing with shock, keep the head low and 
apply warmth to the surface of the body, and give 
stimulants in very smiall and oft-repeated doses. 
When the patient cannot swallow, stimulants can 
be given hypodermically. 

Perhaps the quickest and best way for a nurse 
to deal with a burn is to cover it at once with flour, 
soda, or carron oil ; then wrap the part in soft linen. 
Scalds should be treated in the same manner. In 
case of shock from severe burn stimulants should 
be administered. If fire catches hold of the cloth- 
ing wrap the victim in' a woolen blanket and smother 
the flames. If one must pass through smoke and 
flame hold* a wet towel over the mouth and 
nose. 

Frostbites must be treated in a cool room with 
snow or cold water; if indicated, stimulants may be 
given in small quantities. 

In cases of syncope loosen all the clothing, lay 



56 DISTRICT NURSING. 

the patient with the head lower than the body, and 
apply stimulating inhalations to the nostrils. 

In case of intoxication, let the patient be left 
quiet and resting. 

When in a fit of epilepsy, lay the patient on his 
back, loosen the clothing, and put a cork between 
the teeth to prevent self injury. 

In an attack of hysteria ignore the patient. 

For apoplexy, slightly elevate the head and apply 
cold water; loosen the clothing about the neck 
and waist and apply warmth to the extremities. 
Avoid stimulants. 

In case of heat-stroke have the patient removed 
to the nearest shade possible ; loosen the clothing 
about the neck and waist, take off any constriction, 
such as garters, and sponge the head and body with 
cold water; in extreme cases wrap the entire body 
in sheets kept wet with cold water, and if there is 
depression of the vital powers, stimulants should 
be administered in small quantities ; in cases when 
a high fever is absent and there is much depression, 
no cold need be applied, but mustard applications 
over the heart and on the calves of the legs may be 
used. 

If a person has been nearly drowned, first remove 
all sand and mucus from the mouth and nose, draw 
the tongue gently forward, and turn the patient with 
the face downward in order that the water may 



EMERGENXY CASES AND THEIR TREATMENT. 57 

escape from the air passages ; then, keeping the 
mouth open by a cork or some other hard substance, 
endeavor to induce respiration ; when this is estab- 
lished give stimulants and apply friction and warmth 
to the body ; respiration is not always immediately 
restored and artificial means must be resorted to. 
There are several methods in vogue to induce arti- 
ficial respiration, Sylvester's being as good as any. 
Let the" clothing be loosened and place the patient 
on his back with a roll under his shoulders ; the 
tongue is drawn forward and held in place by a 
bandage or a hat pin ; the attendant, kneeling at 
the head of the patient, grasps his elbows and draws 
them upward until the hands are above the head ; 
this movement elevates the ribs, expands the chest, 
and produces inspiration ; the elbows are then car- 
ried downward, placed by the side, and pressed in- 
ward against the chest, thereby producing expira- 
tion ; these movements are made very slowly, not 
above fifteen a minute, and are continued for two 
hours or more unless respiration is established 
before that time. 

In any case of asphyxia, remove the cause in 
order that the lungs may be supplied with pure 
air; if much depression has resulted from the loss 
of oxygen in the blood, stimulants should be given. 

If any substance is lodged in the larynx, turn 
the patient head downward with a quick jerk, and 
5 



58 DISTRICT NURSING. 

sometimes the obstruction will roll out ; the back 
can be sharply slapped between the shoulders to 
help the patient cough the substance out ; foreign 
bodies in the pharynx are frequently coughed or 
vomited up ; in case of a pin, fish-bone, or other 
sharp substance, the white of an egg may be swal- 
lowed ; if the fingers can reach the offending article 
well and good, but all manipulations must be made 
with great care, and unless there is much pain and 
distress nothing should be done until the doctor 
arrives. 

Bugs in the ear may be drowned out by warm 
water, either syringed or gently poured in. 

Children who have swallowed any foreign sub- 
stances should drink freely of gruel ; no emetics or 
cathartics need be given unless the doctor so orders. 

During convulsions the patient's head should be 
wrapped in cold water compresses and the body 
immersed in a hot bath with mustard in the water. 

Poisons are of two kinds, narcotic and irritant ; 
the first cause no local irritation, the latter destroy 
the tissues with which they come in contact ; in 
any case of poisoning the first treatment is to re- 
move it from the stomach by means of emetics or 
the stomach pump, then the proper antidote is 
administered. Vomiting may be induced by tick- 
ling the throat with a feather, running a finger 
down as far as possible, or by giving common 



EMERGENCY CASES AND THEIR TREATMENT. 59 

emetics, such as mustard in warm water, syrup of 
ipecac, or even warm water. If a person is suffering 
from narcotic poisoning the stomach can be washed 
out by an ordinary fountain syringe, the rubber 
tube without the attachment being introduced 
through the oesophagus ; give strong coffee for 
narcotic poisoning. 

Obstetrical emergencies are dealt with according 
to the general directions given in the best w^orks 
on obstetrical nursing. The handbook written by 
Anna M. Fullerton, M. D., is one of the best works 
of its kind and covers' the ground fully. 

A District Nurse frequently has slight ailments 
to deal with which are of scarcely enough import- 
ance to call in a doctor, such as the extraction of 
splinters, the dressing of blisters, and chafed skin ; 
the first can be gently drawn out with forceps, the 
blisters can have a needle and thread run through 
them to puncture the skin and let out the water, 
while fuller's earth is perhaps the best application 
for a chafed skin. Mutton tallow applied slightly 
warm, and a thin coating left on the excoriated 
parts, is soothing and curative for chapped skin. 

When the skin is abraded cover the wound with 
white of egg or paint with collodion. 

Bedsores are usually left for the nurse to treat. 
Unless the doctor gives special orders as to the 
dressing of these painful and weakening wounds, 



60 DISTRICT NURSING. 

the nurse must use her best judgment in deaHng 
with them. They are far more easily prevented 
than healed ; they are the result of long-continued 
pressure upon particular parts of the body, and all 
bedridden invalids are liable to contract them, most 
particularly those of lowered vitality. Parts subject 
to pressure should be kept very clean, and the 
sheet under the patient quite smooth, the bed quite 
clean, free from wrinkles, crumbs, or lumps; the 
clothing of the patient must likewise be kept quite 
clean and drawn smoothly in place ; the skin may 
be hardened by daily bathing in alcohol ; if there is 
much pressure bathe several times a day, and dust 
the skin with finely powdered oxide of zinc ; re- 
move the pressure from the part by rings of rubber 
or oakum ; water beds are among the luxuries 
which most District Nurses are not yet able to 
command; if bedsores are already formed the alco- 
hol used in bathing must be diluted with water. A 
simple abraded surface may be treated by a dress- 
ing of oxide of zinc ointment ; if slough has formed, 
a charcoal poultice may be required to remove the 
gangrenous portion, after which lint dipped in 
aristol may be placed on the sore. 



CHAPTER VIII. 



SURGICAL NURSING. 
After the surgeon arrives the nurse leaves the 
entire direction of the case to him, holding herself 
ready to assist as he may give orders, and antici- 
pating his wishes, as her previous training has 
taught her to do. Very important operations are 
better performed in a hospital than in most of the 
homes a District Nurse visits, and yet cases of 
major operations where home treatment is the only 
alternative do occasionally fall into her hands. She 
should walk into the house fully determined to 
have the surgeon's orders fulfilled to the letter, in- 
sist upon the best room being used for the patient, 
and get together in the neatest and most convenient 
manner possible such articles as are essential for 
use during and after the operation ; have all per- 
sons not directly interested in the operation sent 
out of the room, and insist upon the apartment 
being quiet. It is for the surgeon to say if any im- 
mediate friend or relative of the patient may or 
may not be present ; but the nurse can strive to 

6i 



62 DISTRICT NURSING. 

quiet and soothe all undue excitement and unwise 
display of feeling. Upon her tact, firmness, and 
discretion, rest the ease with which the surgeon 
can do his work. Where there is time for the 
nurse to send to her headquarters for supplies she 
can procure such things as are needful for the 
operation ; otherwise she may be sadly put to it for 
make-shifts, and to her adaptability the surgeon is 
indebted if he finds no important article, or substi- 
tute for it, lacking as he proceeds to the business 
he is called for. 

In preparing for an operation in district work 
where the people are very poor, the nurse should 
see to it that the room is made as clean as time and 
circumstances will permit; that superfluous articles 
are bundled out of the room ; that the temperature 
of the room is about 70° F. (unless otherwise 
ordered). Have the window so protected that 
nothing can be seen from the outside, while a good 
light falls within. Let a firm, long table for the 
patient to lie upon be brought in ; lacking this, use 
planks upon barrels ; let there be a side-table or 
two or three chairs, to place dressings and instru- 
ments upon ; in every case the nature of the opera- 
tion determines the number and the amount of 
articles needed for use, and a District Nurse under- 
stands what to collect for each special case. If 
possible to avoid it, she should not stint in any way. 



SURGICAL NURSING. 63 

It is a great mistake to suppose that just enough 
or a little less is as good as a bountiful measure. 
With a proper regard for cleanliness, the unused 
articles can be collected and kept in stock for 
another occasion. There must be plenty of soft . 
towels, basins, soap, hot and cold water, at any 
operation. If a District Nurse have a surgical tray 
in her room ready to be sent for on occasion it 
should be so complete that nothing will be lacking. 
The bed of the patient requires attention. In some 
homes the bed and bedding are far too filthy for 
use; for such, the nurse must have her spring cot 
for loaning brought, and such mattresses, pads, and 
bedding supplied as shall make the bed firm and 
comfortable. The cheap oilcloth sold for table- 
covers answers very well for a mattress covering. 
• The nurse should know whether the patient be 
in a fit condition to be etherized or no ; that is, if 
he have partaken of a hearty meal within a short 
time ; and she should properly prepare the patient 
for the ordeal, as in nursing a private case. Pos- 
sibly she may have to administer the anaesthetic. 
The operation fairly over, the bed having been pre- 
viously made ready, the patient is placed as com- 
fortably in it as possible ; while the same attention 
as is requisite in hospital practice to ease the patient, 
if nauseated from the effects of the anaesthetic, is 
needed. The parts operated upon must be kept 



64 DISTRICT NURSING. 

perfectly quiet, and the nurse must take charge of 
the patient as the surgeon leaves. He may have 
given the most explicit directions to the family as 
to the treatment of the case, going into detailed 
particulars, but with her lies the task of enforcing 
attention and knowing that they properly under- 
stand what is to be done. The nurse must rem.ain 
with the patient until he is thoroughly over the 
effects of the ether and is made as comfortable as 
circumstances will permit. Then the room is 
cleaned up, the extra dressings packed in the tray, 
and the family put in charge of the patient. The 
nurse reiterates the directions of the surgeon and 
tries to make them very plain. She particularly 
enjoins the necessity for perfect quietness of body 
on the part of the patient, lest the work of the 
surgeon be undone and made of no avail, points 
out the danger from hemorrhage or from a re-dis- 
location, and tries to divert the mind of the sufferer 
away from his accident and forward to the time 
when he shall have recovered the full use of his 
bodily powers again. If a limb have been removed, 
she can bid him be of good courage and wait 
patiently for the artificial substitute. 

The surgeon may use antiseptic treatment. If 
he does, she very likely brings much of the lint, 
absorbent cotton, disinfectants, etc., in her bag daily 
when she comes to dress the wound. 



SURGICAL NURSING. 65 

In cases of extreme emergency, if the nurse have 
not the needful suppHes, she must beg them if pos- 
sible, for, unless she can have the proper materials 
to work with, she may well give up her work as 
futile. 

If the injury of the patient is of the head, the 
nurse should see to it that the room be kept cool 
and dark. 

If tracheotomy has been performed, the air must 
be moist and warm. 

If such bones have been operated upon, or limbs 
taken off, as require the weight of the bedclothing 
to be taken from the injured part, a cradle can be 
made of barrel staves and hoops. Let there be pads 
under the wound to protect the bed ; these can be 
changed whenever needful for cleanliness. 
• All the precautions needed in surgical nursing 
in hospitals or in private homes are doubly essen- 
tial in district work to prevent blood-poisoning, or 
to keep from taking cold in suppurating wounds. 

All important cases must be visited daily ; 
sometimes twice a day is needful. Any surgical 
case of much import must be the especial care of 
the nurse, and if she cannot herself stay, she should 
endeavor to see to it that some responsible person 
is constantly in charge of the invalid. 



CHAPTER IX. 



SICK CHILDREN. 

These form the major part of nursing in district 
work : partly because of their large number, and 
partly because the District Nurse stands in a sort of 
maternal relation to the mothers of her little com- 
munity. 

Tired, overworked mothers look to her for advice 
and sympathy when their helpless little ones are 
ill, and it is these mothers who most need her ser- 
vices. When children come into a family, the loaf 
must be subdivided. What was competence for 
the young couple when first married, becomes bare 
subsistence by the time the tenth baby arrives, and 
sometimes long before that ; babies die and funeral 
expenses put the family into debt. There may be 
dull times, and work not obtainable ; the husband 
and father may get sick, but expenses go on, and 
he finds it hard to catch up on recovery ; any draw- 
back to regular earnings entails a time of severe 
privation. 

To young mothers just starting to raise a family, 

66 



SICK CHILDREN. 6/ 

the nurse may put the case strongly, enforcing the 
lesson of thrift, and teaching the young couple the 
injustice of bringing more children into the world 
than can be fed properly. Some are reached by her 
words and will pay heed to their doings, and so save • 
the community from the infliction of large, miserable 
families. 

In dealing with those already here, the nurse 
must be kindly and sympathetic. Be the baby the 
youngest of a troop, its rights are the same as if it 
were the only child ; and the mother, worn by ex- 
cessive child-bearing and the care the little folks 
brought with them, is to be pitied for her ignorance 
and helped in her misfortunes. 

So long as all the children keep well, matters run 
comparatively smooth ; a little want is not felt, yet 
the great privations of the poor predispose their 
children to disease ; but, even so, it is always easier 
to keep children well than to restore them to a nor- 
mal condition after they have contracted illness, 
and in teaching mothers how to keep their children 
well the nurse finds much work ; the instincts of 
motherhood will usually lead even a thoughtless 
woman to try to do all she can for her children, 
but, in her ignorance, she makes many and woful 
mistakes. She is so apt to make herself a willing 
slave for them when they are ill, that she often- 
times wears her own strength quite out without 



68 DISTRICT NURSING. 

doing them any good, and all this is mistaken kind- 
ness. 

Children sicken very quickly and recover almost 
as rapidly, and even a slight indisposition in a child 
should not be passed over as of no account, lest it 
prove the precursor of a more serious illness. 

Miss Catharine Wood says : " Illness at first 
shows itself in a child by listlessness and loss of ap- 
petite ; the eyes look heavy ; the child may be fret- 
ful, especially if disturbed, or it may be drowsy ; it 
will feel hot, and, if the temperature be taken, the 
thermometer will generally show an elevation above 
the normal ; but this, in itself, must not be regarded 
with disquiet, as a very little suffices to disturb the 
normal heat of the body ; in nearly all cases there 
will be vomiting and some bowel disturbance, and 
then special symptoms will declare themselves ; . . . . 
the best treatment is to wait and see what is coming, 
at the same time placing the child in favorable cir- 
cumstances ; that is, keeping it quiet and away from 
its fellows, giving it light food easy of digestion, 
seeing that the bowels are not overloaded, and then 
waiting for the diagnosis of the medical attendant." 

Whatever the doctor may direct in regard to the 
child the nurse should see done, teaching the 
mother how to do it, and in teaching her taking 
nothing for granted, but making every step of the 
process plain to her. Sometimes hospital treat- 



SICK CHILDREN. 69 

ment may be advised as being best for the child 
physically and morally. 

Sick children are as individual in their tastes, 
likings, and antipathies as are grown people, and* 
with but little diplomacy in their composition, • 
having not yet learned the value of dissimulation in 
getting on in the world, they openly show their 
likes and dislikes. To nurse a child properly one 
must have its confidence, and the gaining of the 
good-will of the little children is one of the first 
duties of the District Nurse. She needs a mother's 
heart big enough to adopt any member of the 
human family, yet a child, who may need her care, 
and this means a great deal. 

When mothers find their little ones take kindly 
to the nurse and see that she can do with them 
much as she pleases, most will listen to her advice 
as to the management of the little people, and by 
timely hints she can contrive to save many a child 
from serious illness. 

In dealing with a sick child let him be treated as 
nearly like a well one as possible ; that is, let 
regularity of habit be kept up. On first awakening 
in the morning sponge off its face and hands, rinse 
out the mouth, and give some nourishment ; let the 
room be tidied and aired, the clean clothing aired, 
and the patient dressed in fresh clothing and the 
bed made. 



70 DISTRICT NURSING. 

Be very careful not to waken a child out of a 
sound sleep, unless particularly ordered to do so by 
the doctor. 

Be very exact in giving medicine and nourish- 
ment ; if the patient have slept over the hour, give 
it on first awakening, and commence the time table 
anew. 

Keep the room very quiet. 

Avoid too bright a light if it falls directly on the 
eyes of the patient, or in the room, if it seems to 
disturb him. 

Keep the room well ventilated ; always have the 
air sweet and fresh. 

Do not let the patient feel any draught. Cover 
him lightly over when airing the room. 

Remember that children cry continuously only 
from one of two causes, hunger and earache ; if 
children are hungry, and it is not yet time for food, 
let them cry if they cannot be soothed by some 
other means than feeding them. A little cold water 
will often satisfy the thirst. 

To induce a baby to put out its tongue, put a 
little sweet on its lower lip down toward the chin. 

Castor oil can be given in hot milk. 

Babies get thirsty and need a little water to drink 
several times a day. 

Have mothers prepare for night during the day ; 
it saves time and strength. 



SICK CHILDREN. y\ 

Take the temperature of a child by rectum, and 
count the pulse during sleep. 

To give a sick child a bath, wrap him in a warm 
blanket and let him down into the water gradually ; 
the water should be about ioo° Fah. ; on taking 
out after five minutes or so, wrap him in a dry, 
warm blanket and wipe him, without exposure if 
possible, with soft towels. 

Treat children gently so far as handling them is 
concerned, but be firm in carrying out the doctor's 
orders, letting neither tears, screams, nor kicks inter- 
fere with doing your duty. 

In teething children watch the gums lest they 
require lancing ; swollen gums sometimes make 
babies very restless and feverish. 

If children have sore eyes (conjunctivitis) trickle 
upon the lids, letting the stream run toward the 
nose, warm water in which a pinch of salt has been 
dissolved ; this disease is quite contagious, and the 
towel used by a child afflicted with it should never 
be used by other children in the family. 

In sponging a patient do not fill the sponge to 
overflowing, but wring out the water until it will not 
drip when held in the hand. By this means wetting 
the bed clothing is avoided. 

If the doctor orders a cold pack, the child is 
laid on a canvas cot which has been previously 



72 DISTRICT NURSING. 

covered with oilcloth, and over this a large sheet 
laid ; the sheet is folded over him, and the head of 
the cot is raised a little from the floor to allow the 
water to flow toward the foot and into a tub placed 
there to receive it ; a continuous spray of cold 
water is played over the child from an ordinary 
watering*pot ; the doctor advises as to the length 
of time this treatment should be kept up. 

To give a child an enema, turn it on its left side 
with the knees drawn up, and pass the nozzle of 
the syringe into the rectum, directing it a little to 
the left. Force the fluid in gently, and keep it in 
the bowel for some little time after the tube is re- 
moved by holding a folded towel as compress over 
the anus, letting the child remain quiet in the posi- 
tion it was placed. 

. If a leech must be applied, have it in a place out 
of sight of the child. Rub a little sweetened milk 
over the spot where it is to be placed to induce it 
to bite ; when it should come off, drop some salt 
on it and carefully remove it. 

If the bowel protrude, lay the child on its side 
and gently push the intestine back into place ; 
wash the parts with a little warm water and hold 
a warm compress at the anus for a short time. 

No class of sick children appeal more strongly 
to the sympathies of the District Nurse, than those 



SICK CHILDREN. 73 

afflicted with hip disease, or with Pott's disease ; 
such cases require special treatment, which she 
should endeavor to obtain for them. 

Little babies when sick must be closely watched 
for all the objective signs of illness, as, being quite 
unable to tell how they feel, there is little else for the 
doctor to rely upon in diagnosing the disease. All 
the movements, such as the tossings to and fro, 
twitchings, jerkings, the cries, whether they be 
sharp and piercing, or moaning, or long, loud, and 
tearful, and the looks of the child, whether it be 
pale or flushed, should be noted. Asleep or awake 
there is much to be noticed in the appearance of 
a child, and a nurse can tell a mother just what to 
look for in her sick child. 

Babies often have quite a high fever from an 
acute attack of indigestion, a happy trick of Nature 
to alarm the mother in time to the dangers of 
bad feeding, and one that furnishes the nurse a fine 
opportunity to teach the importance of attention to 
the baby, and the need of feeding it judiciously. 

Colic in a baby is sometimes relieved by a few 
spoonfuls of hot water and by putting a hot flannel 
over the abdomen. The food may be too alkaline 
and should be changed. 

In arranging an ice bag for the head, as in con- 
gestion of the brain, the ice should be smashed and 
placed in a flannel bag (if a rubber one cannot be 
6 



74 DISTRICT NURSING. 

procured), with soft towels under it to absorb the 
water ; the pillow for a sick child should be of hair. 

Children in convulsions should be put into hot 
water without waiting for the doctor to come. 

If a baby is restless it can sometimes be soothed 
by turning it into a different position. 

If children will not open the mouth to take medi- 
cines, hold the nostrils between the thumb and 
forefinger ; they will open the mouth to breathe, 
and will swallow during inspiration. 

During the hot weather babies should be very 
simply dressed and kept cool. Heat is one of the 
most potent factors in the production of entero- 
colitis, popularly known as cholera infantum. Babies 
suffering from this should be kept out-of-doors, in 
the parks, or by the seaside during a large part of 
each day; not, however, in the direct rays of the 
sun, nor yet exposed to a draught of air, a sud- 
den chilling of the surface of the body being one 
of the worst possible exposures for a -little child, 
whether sick or well, and at the root of many infan- 
tile disorders. 

The diseases of very young children are notably 
those of the respiratory system, or of the alimentary 
tract, and one of the commonest causes of illness 
is overfeeding ; if for any cause the child is uneasy 
or fretful, the mother snatches it up and nurses it 
or gives it the bottle to suck. Summer complaints. 



SICK CHILDREN. 75 

indigestion, inanition, and entero-colitis are the 
direct result of this course of treatment, therefore, 
to regulate the diet is of the first importance in 
dealing with sick babies ; and as such are apt to be 
quickly amenable to treatment, it proves oftentimes 
all the help they need. 

Mother's milk is undoubtedly the best food for 
infants under one year old, yet babies must be 
individualized in this matter. Some babies thrive 
best on artificial food, and the milk of many 
mothers is poor and lacking in nutritious elements. 
The personal hygiene of any mother who is nursing 
her baby should be closely looked after. It is always 
a pity to feed a child artificially entirely : when a 
woman can nurse her baby part of the time she has 
a recourse in case of illness which the mother who 
depends upon the bottle has not. Nothing soothes 
a fretful, irritable child sooner than suckling it. 

In dealing with all babies who are ill, the nurse 
works under a physician. She is happy if the 
doctor understands infant dietetics. She, however, 
can shirk the grave responsibility of trying this food 
or that preparation until one is found which suits 
the baby's stomach. The doctor is responsible for 
the suggestions, and she congratulates herself that 
he is, for in the matter of infant feeding there 
seems to be a great diversity of opinion ; on a sub- 



jG DISTRICT NURSING. 

ject of such grave import she may well safely rest 
the entire responsibility with the doctor. 

Her duty lies in a diffecent path, and that is, the 
thorny one of knowing that the doctor's sugges- 
tions are heeded and acted upon. The carelessness 
of mothers as regards taking advice as to the feed- 
ing of their children is something stupendous. 
Mere infants are table fed from the time they can 
lay hold of food with their little fists, and the 
baby rules the family in choosing his food ; the 
others do not eat so recklessly, but baby may eat 
anything, provided he does not choke in swallow- 
ing it. 

To get mothers to feed their babies rationally is 
one of the hardest tasks a nurse has to do. 

Dentition in children is a natural process and is 
not always attended with physical disturbances. 
The prevalent opinion amongst poor mothers is, 
that a child must be sick when teething as a matter 
of course; this is a fallacy the nurse must combat. 

After the children are weaned the food must be 
given with judgment. No child is capable of 
choosing what is good for itself. Perverted ap- 
petites are of very sudden growth and strong in 
their demands. A wise mother chooses the food 
which is good for the growing child, and gives him 
no opportunity of rejecting it. She does not refuse 



SICK CHILDREN. 'J'J 

to make it palatable, but she pays no heed to ab- 
normal cravings. 

The children of the very poor are only too apt to 
suffer from an insufficiency of food ; this the nurse 
cannot always remedy ; and by reason of too little 
food and bad surroundings she cannot bring these 
children up to the standard of health they would 
reach under different conditions. 

Rachitic children especially, require a generous 
diet and warm flannel underclothing, particularly 
in cold or damp weather. Children suffering from 
any form of tuberculosis should have food good in 
quality and plenty in quantity. If all such could 
have even a moderately comfortable life the misery 
attendant upon their illness would be greatly 
lessened. 

Specific disorders in small children are usually 
inherited, are difficult of eradication, and the nurse 
must see to it that the advice concerning diet and 
cleanliness is acted upon, that the towel used for 
the afflicted child is not used by any other member 
of the family, and that all proper precautions are 
taken to keep others from being infected with the 
poison. 

In w^hooping cough there is danger that a child 
may die from exhaustion, or that capillary bron- 
chitis may supervene. It is well, therefore, to 
guard against the occurrence of these complica- 



78 DISTRICT NURSING. 

tions early in the disease, and in even slight 
attacks. 

Spasmodic and membranous croups usually 
come on suddenly, and must be dealt with with 
alacrity. The former rarely proves fatal, the latter 
nearly always does. It is considered by many 
physicians as identical with diphtheria, and the 
treatment for it is similar. 

We have found that the steam from washing 
carried on in the home is productive of many ill- 
nesses of the respiratory tract, and very aggravat- 
ing to many more. It is a great pity that in all 
of our large cities some provision is not made for 
having washing done either in public laundries or 
in wash-rooms outside of the tenement houses. 

Children with infantile paralysis, or undeveloped 
muscles are sometimes benefited by massage, while 
cases of malformation should pass under the eye of 
a surgeon before being given up as incurable. 
Then there are always cases of neglected, half- 
starved, and vermin-covered children for the District 
Nurse to look after. To rid children's heads of 
pediculi, the tangled masses of hair should be cut 
off, and the head washed in kerosene oil. After 
the oil bath the head should be wrapped in a towel 
to dry off Extreme cases call for ung. hydrarg., 
which must be used with care, particularly if there 
be sores upon the scalp. 



SICK CHILDREN. 79 

In all skin affections much care must be taken to 
maintain cleanliness, not always by washing in soap 
and water, for this is often interdicted by the 
doctor; but in wiping off the parts with oil and a 
soft rag, and in keeping the clothing scrupulously 
clean. Impure soaps, and hard water, should 
always be avoided in w^ashing children. 



CHAPTER X. 



INFECTIOUS AND CONTAGIOUS DISEASES. 

These ailments form a goodly proportion of those 
a District Nurse has to deal with. There are 
always difficulties in properly caring for them in 
the homes of the poor, isolation in many cases 
being well nigh impossible; but the nurse can 
insist that superfluities be removed from the room 
in which the patient lies ; if the family all live 
in one room, the patient should be removed to a 
hospital as a matter of public health. Such cases 
are to be reported to the Health Boards for their 
supervision. 

In times of cholera epidemic, whole communities 
get roused to taking sanitary precautions ; but a 
neighbor's child may die of diphtheria, and very 
little be thought of it by families contiguous. 
Cholera proves fatal in perhaps half the cases at- 
tacked by it, while a far greater proportion of 
cases striken with diphtheria die, and diphtheria 
germs are readily disseminated and hard to kill. 

Scarlet fever is to be dreaded amongst little 
80 



INFECTIOUS AND CONTAGIOUS DISEASES. 8 1 

children, for although they may recover from the 
fever, there are apt to be sequelae which make the 
lives of the victims a burden. 

When measles or chicken-pox attack the children 
of a neighborhood, dozens may take the diseases, 
unless prompt measures are taken to stamp them 
out. 

There should be a physician to visit every case 
of contagious disease in the home, and the nurse 
must be watchful lest the proper precautions for 
the protection of the family and to prevent the 
further spread of the disease in the neighborhood 
are neglected. The importance of carefulness must 
be impressed upon the minds of the people, and 
much of the w^ork of the nurse lies in giving in- 
structions, such as : — 
' *' Make this room as nearly empty as possible. 

" Have this bed clean, and keep it so. 

'' Keep the air pure. 

" Protect the patient from a draught. 

" No one except the one caring for this patient 
shall come into this room. 

'' Keep a w^ash dress to w^ear in this room, pro- 
tecting the hair by a close-fitting cap. 

" Nothing used about the patient or in this room 
shall be taken from^ the room until it has been 
washed in boiling water." 

If the patient is dying, do not let the family 



82 DISTRICT NURSING. 

gather around, but instruct them to quietly submit 
to the inevitable. They should be taught to save 
their own strength, to care for the invalid in turns, 
and to eat before going into the room. 

It is not an impossible matter to prevent disease 
spreading. Boiling water will kill the germs of 
most diseases ; and an abundance of pure air will 
oxidize and purify any putrid matter there may be. 
In ventilating the sick-room do not let the air blow 
into the other rooms in the apartment, nor yet let 
the family suppose that because disinfecting solu- 
tions are freely used that they can dispense with 
pure air ; no disinfectant is so valuable or takes the 
place of this ; we think it far better to abstain from 
using any sweet-smelling deodorizer to deaden the 
foul smells of a room, for the reason that so many 
consider this all that is needful ; it is better to let 
people comprehend that all foul odors can be dis- 
sipated in the free air, only have the quantity 
sufficient. 

The family should be made to understand that 
the amount of disease germs are circumscribed ; 
they may be practically countless, yet there is an 
end to their number, and every one destroyed is one 
less to inoculate some one else with ; teach them to 
thoroughly disinfect the vomit, the sputa, and the 
defecations of the patient ; if the disease is com- 
municable through the desquamation of the skin. 



INFECTIOUS AND CONTAGIOUS DISEASES. 83 

let the body be rubbed with oil to prevent the scaly 
particles flying off into the air. 

If a nurse in making her rounds finds a child 
ailing without any disease having positively de- 
veloped itself, let her watch the child carefully for a 
few days lest it be coming down with some con- 
tagious disease ; if there be no doctor in attendance, 
let her above all things examine its throat ; let her 
instruct the mother to give it a warm bath at bed- 
time and keep it out of draughts, and to watch for 
the appearance of any rash upon the surface, and to 
note the nature of the eruption if any appear. 

Some diseases are more readily communicable 
than others. Smallpox is given at any stage and 
can be taken from a patient even during the period 
of incubation. It is more generally dreaded than 
any other ailment, and people will take precaution- 
ary measures to avoid it more readily than in case 
of any other disease. In all large cities the Health 
Boards attend to the vaccination of the poor, and 
the public schools reject pupils who are not 
vaccinated. The germs of smallpox are long-lived 
and develop under suitable conditions from hidden 
sources, so that the public do well to guard against 
it. If a case appears it is immediately removed to 
a special hospital for treatment. 

The risk of infection from measles and whooping- 
cough is greatest in each in the early stage of the 



84 DISTRICT NURSING. 

disease. Scarlet fever is most readily taken during 
the third or fourth week, when the skin begins to 
peel ; typhus fever germs are not nearly so infec- 
tious as those of typhoid, but in certain conditions 
of the system they are readily developed. Typhoid 
fever, yellow fever, cholera, and dysentery are not 
directly transmissible. The excretions are the 
media through which the germs are carried into the 
atmosphere gr into the water, and from thence 
taken up into human systems. They are sometimes 
drank in infected milk. 

In nursing these cases, everything that comes 
from the patient should be disinfected by pouring 
over it boiling water. This is the simplest and 
easiest method of dealing with all excreta. If 
there is a lack of flush water supply in the water 
closet these excreta may be mixed with sawdust 
and burned. 

Of all the scourges which visit the homes of the 
poor we think diphtheria the one to be the most 
dreaded. It attacks chiefly young children from 
two to nine years of age; and if one member of 
the family has it the others are quite liable to take 
it. The simplest precautions against infection from 
diphtheria are, to avoid inhaling the patient's breath 
or other exhalations from his body ; be very care- 
ful that nothing spit from the mouth lodge any- 
where to dry and become diff'used in fine particles 



INFECTIOUS AND CONTAGIOUS DISEASES. 85 

through the air; let one person at a time only be 
in attendance upon the patient ; let no one who has 
the care of the patient go into the room hungry or 
too tired, if the weariness can be avoided, and let 
the attendants as well as all the members of the 
family gargle their mouths and throats with salt 
vinegar and water. Diphtheria germs will not thrive 
in acid secretions. 

In any case where a child has a throat dusky red, 
let it be gargled with the mixture of salt, vinegar, 
and water, and call a doctor's attention to the child ; 
it is better to be over particular in trying to prevent 
diphtheria than a little careless. 

When a contagious disease ends by the patient's 
recovery, or by his death, the room he has been in 
should be disinfected ; if the patient dies, all the 
clothing used about him should be at once burned; 
if this seems too much of a hardship, they must at 
least be put into boiling water, and boiled for some 
time, and then rinsed in a solution made of — 

Sulphate of zinc, 4 ozs. 

Common salt, 2 ozs. 

Hot water, I gall. 

The clothes may be soaked in this for two hours, 
and then washed out in the usual manner. 

After death occurs, there should be as little hand- 
ling of the dead body as possible, and the funeral 
should be strictly private. 



86 DISTRICT NURSING. 

The walls of the room vacated should be washed 
down with a disinfectant and the room fumigated 
with sulphur. In burning sulphur it is well to 
remember that the best effects are obtained only 
in a moist atmosphere, so that kettles of boiling 
water should be put into the room just before the 
sulphur is ignited. The steam can be increased by- 
putting into these kettles very hot bricks. A room 
may be opened twenty-four hours after fumigation 
and thoroughly ventilated. 

All drains and closets should occasionally be 
flushed with boiling water. Copperas, and chloride 
of lime, may be thrown into them dry. 

There are dozens of disinfecting solutions, but 
unless the physician in charge of the case order a 
special one, the District Nurse can ver)^ well manage 
with plenty of pure air, boiling water, and bichloride 
of mercury, the latter to be used by herself, as, 
being a deadly poison, she may not trust it for 
family use. 

In dealing with contagious diseases the sputa of 
consumptives should not be overlooked; every 
consumptive should be taught to spit either in old 
rags or soft papers which can be burned, for the 
dried particles of sputa which rub off from the 
handkerchief, clothing, or any receptacle which con- 
tains it will float in the air and, coming in contact 
v/ith a mucous membrane ready to receive it, will 



INFECTIOUS AND CONTAGIOUS DISEASES. 8/ 

produce consumption in the new patient. As con- 
sumptives near the end some things can be done 
by the nurse toward alleviating their suffering, such 
as elevating and bandaging their lower limxbs if 
swollen, applying dry heat or friction over the 
thorax to relieve pain, and giving some warm drink 
early in the morning to ease the vomiting. For 
hemorrhages table-salt can be given, and for night 
sweats the body can be lightly sponged off with 
alcohol and water; the garments worn during the 
night can be taken off, turned, shaken in the open 
air, sunned, aired, and alternated with another set 
to keep them fresh and comfortable; and tasty 
nutritious foods, can be prepared. 

It is usually customary for the visiting nurse to 
confine her services to these cases exclusively when 
attending them. Many societies make this an 
imperative rule. When a society has several nurses 
working under it one can easily be detailed to such 
cases. This, of course, does not apply to consump- 
tive patients, but only to such diseases as are spread 
through contact. A careless nurse could easily do 
more harm than good if she disseminated disease 
germs from one house to another. 



CHAPTER XL 



MEDICAL NURSING. 

The District Nurse finds that in the course of her 
work she deals with many and various diseases, 
and that she must understand the general treatment 
of them all. 

For convenience, she classifies them under dif- 
ferent types, and suits the general treatment to the 
special needs of each case as best she can. 

There are chronic cases to be dealt with ; those 
that general hospitals do not care to take, as being 
in the main incurable and of no special clinical 
interest. The consumptives already spoken of are 
found among this class; for a patient suffering 
from consumption the treatment given by the 
nurse is palliative. She tries to make the 
ventilation of the apartment as complete as 
possible, and to see that the invalid has as good 
food and care as she can arrange for. One im- 
portant factor in dealing with respiratory troubles 
lies in teaching the patients how to cough. This 
should be after a full inspiration. Coughing in ex- 



MEDICAL NURSING. 89 

piration helps to force out accumulated matter 
with the air, as unavaihng hacking does not. A 
provocative cause of lung trouble is the steam 
from damp clothes, and it is one of the miseries of 
the very poor, that the smell from wet garments 
must be inhaled, when they are drying by the only 
fire to be afforded. 

In tending upon cancerous patients the nurse 
must insist upon perfect cleanliness of dressings in 
order to keep the foul odors subdued. 

In kidney and heart troubles the District Nurse 
can usually do a good deal toward alleviating the 
miseries the patients must endure. She can band- 
age swollen limbs, procure easy chairs, and other 
sick-room appliances, and brighten their lives in 
many ways. 

In caring for fever patients the nurse must teach 
the members of the family how to give baths ; to 
take the temperature, respiration, and pulse; how 
to feed the patient; how to change the bed-linen; 
in fact, the entire minutiae of fever nursing, as she 
cannot be present during any lengthened time, and 
the attendance upon fever patients must be con- 
stant. 

This matter of teaching nursing applies to very 

much of the work of the nurse ; she must show 

others how to do nursing easily and well, by actual 

bedside instruction. In different sicknesses a 

7 



90 DISTRICT NURSING. 

screen is needed. An ordinary clothes-horse 
covered with a blanket is a very good improvised 
one. A simple bed-rest is formed by a chair placed 
behind pillows. In such illnesses as require much 
lifting of the patients the nurse should assist 
when she can be present, and show the family how 
to manage when she is absent, and this with the 
least annoyance to the patient. She must be cau- 
tious in handling medicines, and impress upon the 
attendants the importance of exactness as to quan- 
tity and time of administration. She must teach 
them also to watch a sick patient during the early 
morning hours, just before daybreak, when vitality 
is at its lowest ebb, and the air is apt to be chilly. 
If the patient seem to need it, external warmth 
should be applied and warm drinks given. 

In special instances the doctor in charge will 
rely upon the District Nurse to personally perform 
such duties as cupping, leeching, giving enemata, 
etc., etc. There are always many such things she 
must do, and she arranges with the physician as to 
times and metho'ds. 

In some forms of gastric and intestinal disorders, 
perfect rest in bed must be insisted upon, and the 
diet carefully looked after. In the matter of feed- 
ing these patients the District Nurse must be on 
her guard, explicit in her directions, entering into 
a minutiae of detail which the doctor cannot take 



MEDICAL NURSING. 9 I 

time to do ; showing how to prepare the food per- 
fectly, and how to serve it in a neat, orderly 
manner. 

For patients suffering from gastritis, dysentery, 
diarrhoea, and peritonitis the stomach and bowels 
should be kept warm by a light flannel bandage, 
but no weight of bedclothes should be allowed ; the 
bed-pan should be warmed before use, and boiling 
water poured over the stools before the pan be 
emptied. So far as possible, keep all odors of the 
kitchen from the sick-room. 

In the event of approaching death the District 
Nurse must prove herself the sympathetic friend. 
In such seasons of grief there is the touch of hum.an 
sympathy which makes all men kin ; rank, station, 
and wealth produce seeming inequalities, which 
sink into comparative insignificance in the presence 
of the arch enemy of the human race. Busy 
doctors cannot always take time to stand by and 
comfort the living and ease the dying. The District 
Nurse can usually do so. 

Too frequently there is no money to pay funeral 
expenses. We think it should be the aim of every 
District Nurse to have a fund to loan on such 
occasions. Whether or no this fund may not be 
the investments of the poor themselves is a mooted 
question. We think it easily might be. Penny 
savings make dollars if long enough continued ; 



92 DISTRICT NURSING. 

and a sort of mutual insurance company could 
readily be started in almost any neighborhood. 
Business men have found the advantage of such 
investments. We find the carrying of a small life 
insurance policy not an uncommon thing among 
the very poor. That there may be slight grief 
shown at the loss of one whose life is insured is 
apparent enough at times, for one of the evils of 
extreme poverty lies in its tendency to callously 
harden the finer feelings; yet with vigilance on the 
part of the doctors in signing death certificates any 
criminal carelessness as regards the treatment of 
the sick whose lives are insured can be reduced to 
a minimum amongst the poorer classes. 



CHAPTER XII. 



FEVER NURSING. 

Fever in the human system is always marked by 
a rise in temperature, and this is usually ac- 
companied by increased frequency of respiration 
and a heightened pulse-rate ; it may be due to 
many different causes and may accompany many 
different diseases. Both the muscles and the 
nerves are affected by fevers, and in nursing any 
case of fever both rest and quiet should be insisted 
upon. To the observer watching the course of a 
fever, there seems to be a sort of conflict going on 
to decide as to the resisting power of the individual 
to the injurious effects of prolonged high tempera- 
ture. 

Heat of the body is dissipated through the skin, 
and is used in the respiratory acts : hence the sick- 
room should be airy, well ventilated, and with an 
even temperature of about 60^ F. ; the bed, how- 
ever, must be placed out of a direct draught, as this, 
blowing over a patient tends to check the free ac- 
tion of the skin ; let the clothing and bed-covering 

93 



94 DISTRICT NURSING. 

be light, yet sufficient to protect the patient from 
variations in the external temperature; both must 
be frequently changed, as the effluvia from a patient 
suffering from fever is offensive and unwholesome ; 
the skin should be frequently sponged off with tepid 
water, or with water and a little vinegar or alcohol 
or bay rum; this helps to keep it from becoming 
dry and harsh and from losing its elasticity and 
power of throwing off waste products. 

During the course of any fever the functions of 
digestion are apt to be more or less impaired, ren- 
dering the administration of food in small quantity, 
yet at short intervals, a necessity. Milk as food, 
and water to slake thirst, can usually be freely 
given; in any exceptional case the physician will 
give orders to the contrary ; let the food be given 
with regularity. 

Fevers, according to their type, may be ushered 
in by a severe chill or by one less pronounced, or 
yet may be preceded by a longer or shorter season 
of malaise, lassitude, drowsiness, or by restlessness, 
vomiting, or irritability, with, perhaps, headache. 
In children very trivial ailments may be accom- 
panied by a fever quite out of the ordinary propor- 
tion of rise of temperature to disease in the adult. 
A child will have high and low temperatures vary- 
ing in the most irregular manner, and yet be not so 
very sick ; the safest way in either child or adult is 



FEVER NURSING. 95 

to go at once to bed and await developments ; if the 
fever passes quickly off, well and good ; if it has 
come to run a longer course, the system is fortified 
against the disease by resting in the early start. 

Fevers are classified according to the causes pro- 
ducing them, their general effects upon the system, 
and the symptoms attending them ; in any case of 
fever it is best for the patient to remain in bed so 
long as the attack continues. Good nursing in the 
case of fever patients consists in keeping the air of 
the room fresh and wholesome, the patient, his bed, 
and his room clean, maintaining quiet, alleviating 
distressing sym^ptoms so far as possible, and observ- 
ing the utmost regularity in giving food and 
medicine. 

To keep the air of a sick-room wholesome there 
must be a constant supply of pure air coming in, 
and some means of exit for the vitiated air. If the 
weather is too cold to admit of the window being 
constantly open, the patient can be well covered, the 
window thrown open top and bottom, and the door 
swung rapidly back and forth ; this winnows the air 
and changes all in the room in a very few minutes. 
To protect a patient from a draught an improvised 
screen can be made of a clothes-horse covered with 
a blanket. 

To ensure the cleanliness of the patient and his 
bed, there must be frequent changes of linen. Soft 



g6 DISTRICT NURSING. 

old clothing and bedding, are by far the best in case 
of fever. The person of the patient must be 
frequently sponged off, and any soilure of the cloth- 
ing or bed at once remov^ed ; and everything about 
the patient kept fresh and sweet. In bathing a 
patient who is weak, only a portion of the body 
need be gone over with at a time. Either tepid 
water, or water and vinegar, or water and alcohol, 
or yet water mixed with bay rum may be used for 
bathing purposes. If the patient be too weak to 
rise, the body linen may be torn up the back ; the 
sleeves can be easily slipped off and on ; sheets can 
be rolled under a patient from side to side. Bathe 
the patient before putting on the fresh linen. Be- 
ginning at the face and neck, pass the sponge 
rapidly down over the upper limbs and trunk and 
down the lower limbs to the feet. The patient may 
be rolled to one side and the back lightly gone 
over ; this is all done by passing the hand contain- 
ing the wet sponge underneath the sheet or 
blanket. 

All noises so far as possible should be kept far 
from the sick one; the step of the attendant should 
be soft and springy rather than shuffling and heavy. 
Any one caring for a person very ill should learn 
to move quietly about the room, performing all the 
little offices of the nurse noiselessly as well as 
deftly. No starched dresses or rustling skirts 



FEVER NURSING. 9/ 

should be worn, nor should the fire be poked and 
coal rattled in keeping up the heat ; the ashes can 
be gently shaken down and coal dropped piece by 
piece in paper to renew the fire. No loud talking 
should be indulged in within hearing of the 
patient. 

The methods of alleviating the symptoms of 
fever largely depend upon the kind of fever and the 
treatment adopted by the doctor attending the case. 
Any very bright light should be excluded from the 
room of a fever patient, although it is a mistake to 
keep the room too dark. 

In the milder cases of continued fever cooling 
drinks, particularly alkaline waters, such as Seltzer 
or Vichy, can be given, and milk, light broths, cus- 
tards, whey, and jellies taken for food. 

• In almost any fever the hour just before dawn, or 
from three to five in the morning, when the vital 
powers are at their lowest, is apt to be one of 
extreme depression ; frequently the patient requires 
artificial heat and some stimulus given at this 
hour. 

The visiting nurse supplies the blanks for keep- 
ing the record of her patient's condition, and fills 
out the bedside notes so far as she is able herself, 
but depends upon the family to aid her so far 
as practicable. The temperature can be taken 



9o DISTRICT NURSING. 

by placing the thermometer under the tongue, in 
the axilla, or yet in the rectum. The latter is by 
far the best way with children. The mercury in the 
instrument is shaken down below the normal degree 
of 98° F., and the bulb is placed in one of the posi- 
tions indicated, and kept there from five to seven 
minutes ; the rise will mark the degree of fever. 
When removed from the body the thermometer 
should be carefully washed and returned to its case. 
If the doctor desires the temperature taken fre- 
quently the nurse must instruct some member of the 
family how to do it. If there is no watch .in the 
house by which to count the respiration and pulse, 
the second-hand of a clock will answer. 

The food and medicine must be given just as the 
doctor orders, promptly on time and exact as to 
quantity. If the patient sleep over the hour the 
doctor will probably have left his instructions so 
explicit as to cover such an exigency. If he has 
not, have the family ask for directions at his next 
visit. 

A patient suffering from fever should not be need- 
lessly disturbed ; the nurse or attendant should 
avoid fussiness. A drink will often be taken if 
placed at the lips when the patient is too weak to 
ask for it. 

Parched lips and cracked, should have a little 



FEVER NURSING. 99 

glycerine applied on a soft linen rag quite fre- 
quently; and sordes on the teeth should be cleaned 
off with soft rags. 

Sometimes there may be distressful vomiting 
which does not yield to the remedies given. A 
nurse may use such simple means as a weak mus- 
tard plaster over the stomach, or if the skin is too 
irritable to bear this, a little bruised mint, such as 
is found at the green-grocers, wetted with brandy, 
may be laid over the stomach, or a slice of toast 
wetted with brandy may be used in the same 
way. 

The pillow of a fever patient should be frequently 
turned and shaken to keep it cool and soft. A 
patient should not be lifted suddenly to take either 
food or drink or medicine, or for any other cause. 
If the heart is in any degree weak, this sudden 
movement may cause it to stop beating. Some of 
the cases of heart failure arise from this cause, no 
doubt. 

Delirious patients must be watched w^ith unre- 
mitting attention, lest they get up and harm them- 
selves. Headache may sometimes be relieved by 
cold compresses applied over the forehead or ice- 
bags to the head. In summer time the air of the 
room may be extremely hot. To cool the atmos- 
phere cold water may be poured over the floor, or 
sheets or blankets wrung out of ice-water hung 



lOO DISTRICT NURSING. 

about the room. To relieve extreme thirst bits of 
cracked ice may be frequently put into the mouth. 

Frequently fever patients relish their food and 
drink extremely cold. The beef-tea may be frozen 
for such. Those who can retain very little on their 
stomach will frequently keep down a few spoonfuls 
of clam broth, or a little plain ice-cream, when 
other food would be thrown up. In some cases hot 
milk can be taken with benefit. 

The special directions for nursing different fevers 
depend largely upon the mode of treatment of the 
doctor in charge. The nurse finds out his special 
methods and instructs the family of the patient ac- 
cordingly. When stimulus is ordered it must be 
given as exact in quantity as the medicine is in 
dosage. The nurse must prepare the family to 
meet emergencies as best she can. 



CHAPTER XIII. 



OBSTETRICAL NURSING. * 

The little babies keep coming, and although small 
boys and girls in the city do not suppose they grow 
on apple trees, that fiction being reserved for the 
comprehension of country lads and lasses, yet a 
great many children do suppose that the doctor or 
the nurse brings them, and on her temper in the 
matter lies the reception the little strangers receive 
in homes already full to overflowing. Every baby 
should have a birthright of welcome and love; that 
every one does not is a misfortune and a disgrace. 
Finding a woman anticipating a near confinement, 
the nurse must speak as happily and encouragingly 
to her as she can, and strive to help her in all little 
ways possible to make ready for the expected new- 
comer. Doctors can always be found to look after 
these cases, and one should be engaged sufficiently 
long beforehand to make the proper examination 
and arrangements for the approaching lying in. 
The nurse should see to it that the needful appli- 
ances be not lacking. If she be caring for patients ill 

lOl 



I02 DISTRICT NURSING. 

with contagious disease she should send a substi- 
tute to the lying-in patients. No District Nurse 
should feel bound to go to such cases in the night; 
the woman can usually find some friend or neighbor 
to be with her during labor ; but if the nurse have 
taken a proper interest in the case the arrangements 
have been well made beforehand and everything 
needful is in readiness. 

It occasionally falls to the lot of a nurse to 
deliver a woman, and she should be well prepared 
for such an emergency. A Httle hand-book on 
obstetrical nursing, written by Anna M. Fullerton, 
M. D., completely covers the ground, and in such a 
masterly way as to leave us no alternative but to 
recommend it as a text-book for all District Nurses. 
It is published by P. Blakiston & Son, of Philadel- 
phia. 

Obstetrical nursing in district work has some 
drawbacks which are not met with in private prac- 
tice or in hospital treatment. These are chiefly in 
the way of carrying out antiseptic treatment; the 
room, the bed, and the clothing of the lying-in 
woman may be filthy ; they are rarely ever clean ; 
and the most the nurse can do is to approximate 
toward cleanliness. 

Hard work and poor food may have reduced the 
woman's strength so that she makes a slow recovery. 
Very rarely, however, does a District Nurse find it 



OBSTETRICAL NURSING. IO3 

needful to visit the mother or child after the tenth 
day; by that time she is able to be up and can dress 
the baby herself, although the nurse cautions the 
mother not to take up all of her work for some- 
time longer. 

We have met women who resumed their labors 
in outside work, washing, scrubbing, and the like, 
by the third week with no apparent discomfort, yet 
we never advise any woman to such a course, but 
would rather prevent a suckling woman from doing 
any work outside her own family if possible. 

When the nurse has met the woman some little 
time before the confinement she can explain many 
hygienic laws, so that mother and child are great 
gainers thereby. Very young mothers have need 
to be taught nearly everything in regard to the 
morale, of motherhood — how to work, how to 
sleep, the regulation of their marital relations, how 
to eat, and how to prepare for the baby. Women 
who have already borne children do not always ac- 
quire wisdom by experience. The nurse finds that she 
must feel the way to the understanding of different 
women and adapt her teachings to the need of each 
individual patient. 



CHAPTER XIV. 



TEACHING IN THE HOMES. 

In her visitations from house to house the District 
Nurse sees much that can be righted; the import- 
ance of setting matters straight grows upon her, 
and she cannot hold her peace, even if she did not 
consider teaching as a part of her work. Her 
position makes her a natural Mentor to the people 
she visits. 

But one thing must always be kept in mind, and 
that is that people do not like to be preached at 
even by the most kindly disposed ; and a very large 
proportion of the poor will equally resent being 
patronized; being *' apt to teach" therefore means 
being very gentle, kindly, and tactful. Lessons are 
usually given as side issues ; they may be the 
principal object of the visit and do the most per- 
manent good, but ostensibly they are not the 
primary cause of the call of the District Nurse. 
Let poor people once get the idea that nurses go 
about as general nuisance inspectors and critics 
of their mode of life, they will speedily cease to 

104 



TEACHING IN THE HOMES. IO5 

make her welcome in their homes ; but having won 
her way to their hearts, she can usually find a way 
to their heads as well, and manage to give many 
a lesson in personal and household hygiene which 
will bear fruit in after years. 

The question. What to teach ? opens up a wide 
vista. All knowledge w^hich shall tend to better 
people physically, and so improve mind and morals 
as well, is surely a nurse's province ; but it must be 
conveyed in simple form easily understood. 

But as practically there must be limits, a nurse 
must systematize her teaching, and work upon well- 
defined lines. She should show^ people how to 
make their homes neat and wholesome, and how 
to keep their bodies strong and well ; also the 
simplest and easiest ways of caring for their sick ; 
the amplification of these subjects, even in con- 
densed form, could be made to fill volumes, so that 
a nurse need never feel that her lines are restricted 
even if she do riot touch upon all the ologies and 
isms in the universe. 

Combined with her work, simple popular lectures 
to small audiences can be given with manifest 
benefit ; it is as easy to talk to a dozen or more upon 
some subjects as to one. 

To draw out a classified schedule of lessons to be 
given, properly arranged in regular sequence, would 



I06 DISTRICT NURSING. 

comprise a volume in itself. We will in this work, 
therefore, only touch upon a few points which it is 
.well, we think, to make prominent in teaching. 

Teach the importance of cleanliness in the house, 
particularly the keeping of water-closets and privies 
free from filth and bad smells. 

Teach the importance of good ventilation, and 
show how best to secure it. 

Show also how to economize heat, and yet have 
pure air to breathe. 

Teach the need of clean, comfortable beds. 

Show famiHes how to secure privacy for the dif- 
ferent members when living in crowded rooms. 

Exalt the dignity of simplicity. 

Teach plain, nutritious cookery. 

Try to save young, growing girls approaching 
puberty from overwork, exposure to evil influences, 
and undue care. 

Teach members of families to respect one 
another's rights. 

Try to save mothers from overwork and worry. 

Show mothers how to dress their children. 

Teach the importance of regular habits, par- 
ticularly as regards the daily evacuation of the 
bowels. 

Teach the need of thrift in preserving a proper 
self-respect. 



TEACHING IN THE HOMES. TO/ 

Teach the wrongfuhiess of excess in all ways, 
and the wickedness of indulgence in unlawful pas- 
sions. 

Help the poor to make the most of their con- 
veniences in sickness, and show them how to give 
the invalid proper attention without infringing on 
the rights of other members of the family. 

Try to overcome the prejudice to hospital treat- 
ment when such would be manifestly the best. 

And, above all, try to convince people that a 
very great part of medication lies outside the use 
of drugs ; for ignorant people of all classes seem 
to look upon human bodies much as they do upon 
clocks ; if they are out of running order a little 
tinkering by way of surgery, or a few drops of oil 
administered in the form of nauseous dosage, or a 
good cleaning, such as a violent cathartic will pro- 
duce, is all that is required to put it in perfect order 
again. The wonderful mechanism is as much be- 
yond their powers of comprehension as the differen- 
tial calculus beyond the powers of the little school- 
boy struggling to form the numerals upon his 
slate. 

In all teaching the nurse must rely largely upon 
the confidence she has inspired, in order that the 
people may take her words upon trust and in good 
faith. She cannot always make plain even the fun- 
damental truths underlying her words. She must 



I08 DISTRICT NURSING. 

sometimes assert, '' Do as I say, for I know best; *' 
impressing upon people that the Hne of obedience 
is the only safe one for them to follow. 

Elementary instruction is well enough, and know- 
ledge that is more than elementary an excellent 
thing; but multitudes never will be able to grasp 
physical truths in anything like fullness enough to 
be of great practical service to them. Such people 
must always be dealt with through the confidence 
which inspires them to follow blindly the stronger 
mind. 

This is a truth which those who deal much with 
the poorest people find forced upon them, however 
loth they may be to accept it in its ultimate con- 
clusions. 

District Nurses deal with facts, and very stub- 
born ones, and a comparison of different members 
of the human race as regards intellectual, capacity 
she finds presents marvelous inequalities. 



CHAPTER XV. 



COOKERY FOR THE SICK POOR. 

Many of the diseases of the very poor are 
directly induced by want of nourishing food, and 
the lowered vitality consequent upon a lack of 
proper nutriment has compelled many a person 
amongst them to seek the help they feel they need 
in alcoholic stimulus. 

Insufficient food materials and slatternly cooks 
have done more to keep open the smaller liquor 
stores than all other causes combined ; and to our 
temperance crusaders, we would from what we have 
seen suggest, that good nutritious food, be made as 
cheap as poor whisky. When this is done a long 
stride has been taken toward closing the market 
for vile whisky and manufactured beer. 

In dealing with the sick poor the District Nurse 
reaches those who suffer more from an inability to 
get food than a well-to-do public can have much 
conception of Such things must be seen to be ap- 
preciated. 

Good groceries, meats, and other food products 
109 



no DISTRICT NURSING. 

cost as much for poor people as they do for rich 
ones, and the needs of the human body in both 
classes are pretty much the same. It is a very com- 
mon, yet a mistaken, idea that the table of a rich 
family should of necessity be much more costly 
than that of a poor family. If the approximate 
cost were more nearly the same it would be better 
for both parties in multitudes of instances. 

In speaking thus I would not be understood as 
making a sweeping assertion that all expensive 
luxuries should be dispensed with on the tables of 
the rich, or that the very poor cannot study a wise 
economy even in necessities. Only, that the general 
amount of food ingested by the human body to 
keep up the highest physical health should be so 
nearly alike, in both rich and poor, that the cost of 
this food cannot vary so widely as an unscientific 
public might suppose. 

If the rich partake too freely of highly concen- 
trated foods they induce special diseases about as 
hard to combat as those ailments brought about by 
a low, meagre diet. 

Amongst all classes much good food is spoiled 
in the cooking, and when even one meal is rendered 
unpalatable by the poor woman her family must 
suffer for it. 

One of the greatest possible safeguards toward 
the moral and physical health of the lower classes 



COOKERY FOR THE SICK POOR. I I I 

is in multiplying little shops where good, pure 
foods may be purchased at a trifling advance over 
wholesale cost prices. Call them diet-kitchens, 
soup-houses, anything you will, only make them a 
reality and give them a local habitat. 

In all cases of ordinary disease the food differs 
from that required in health by being somewhat 
lighter both in quantity and quality. Special dis- 
eases, such as diabetes or gastritis, must be spe- 
cially dieted, and by the orders of the physician in 
charge. 

In cooking for the sick poor, therefore, a District 
Nurse tries to bear in mind that a wise selection of 
necessities is needful, in order that not a particle of 
food may be wasted. If she cannot always stop to 
do the actual work, she can carefully instruct the 
family in just how to prepare an appetizing meal 
for the invalid. 

And she can see to it that it is served nicely ; 
one of the reasons the poor look so distressed is 
the dirty manner in which they eat their food. 
Very good viands are sometimes served with as 
little regard for decency as though the family were 
dumb brutes. It is never very difficult for a nurse 
to procure some decencies in the way of old table- 
linen and napkins, and these, carefully laundried, 
make the invalid's tray look neat. 



112 DISTRICT NURSING. 

All water used for drinking purposes should be 
first boiled and then allowed to cool ; this is better 
than iced water. 

Milk used for little children should be sterilized ; 
this is best done by putting fresh cow's milk into 
small, clean bottles ; small, new soda-water bottles 
are good for this purpose ; a bit of absorbent 
cotton is fitted in with the cork, and the bottles are 
set upon little blocks of wood in a boiler of cold 
water; the milk is brought to scalding heat without 
actually boiling it; it is kept at this temperature 
about twenty minutes ; the bottles are then cooled 
off and kept corked until needed for use. 

Artificial koumiss is made from fresh milk ; to 
each pint of milk a tablespoonful of good yeast is 
added ; also a iablespoonful of sugar ; the milk is 
put into bottles or jars and is kept at the tempera- 
ture of about 80^ F. for six hours ; the bottles are 
shaken occasionally while the contents are ferment- 
ing. The milk is then kept in a cool place for two 
or three days, when it is ready for use. 

Curds and whey are frequently relished by an 
invalid; it can be prepared with rennet; a nurse 
should keep a bottle of this ready for use. 

A glass of warm milk is frequently the most 
nutritious food which can be given to a sick person ; 
it should be drunk very slowly. 



COOKERY FOR THE SICK POOR. II3 

Fresh buttermilk for those who like it is often 
good and nutritious. 

In all foods a very little salt should be mixed — 
in the milk for babies as well as the stronger foods 
for adults, salt being the '^ chief agent by which 
osmosis through animal membrane is effected." 

Porridges and gruels should be made in a double 
saucepan ; a pail set in a pot of hot water will 
serve the purpose and they should not be burned 
or smoked. Smoked gruel is distasteful to any 
sick person, yet the poor invalid feels compelled to 
eat it rather than waste it, or go without. All 
gruels should be well cooked ; a raw taste is 
almost as bad as a smoky flavor. 

A very good soup for an invalid is made by boil- 
ing one cup of barley and the same quantity of 
wheat grits in a quart of water very slowly for 
two and a half hours ; add a cup of rice and con- 
tinue to boil until the rice is soft; pass through a 
sieve and add stock to make the soup of creamy 
consistency; season with salt and pepper, bring the 
whole to a boil, and on removing from the fire stir 
in gradually the yolk of an egg. 

A raw egg may be lightly beaten into a cup of 
weak coffee, tea, or cocoa; this is nourishing. 

A white of egg well beaten with a pinch of salt, a 
teaspoonful of lemon juice, and the same of sugar 
can be taken when a light nourishment is required ; 



114 DISTRICT NURSING. 

the yolk of the egg can be beaten in a glass of 
milk, or, made into a cup custard for some other 
member of the family if the patient cannot use it. 

Cottage cheese is frequently very wholesome for 
convalescing patients. 

An excellent mutton broth is made by adding to 
each pound of lean mutton one quart of water, a 
little chopped parsley and celery, and a handful of 
barley, letting the whole simmer three hours before 
straining. Every particle of fat should be taken off 
from the top before reheating the broth for use. 

Lean beef just warmed over the fire without 
being burnt can have the juice pressed out by a 
lemon-squeezer; this juice is very nourishing; it 
can be added to milk; in summer time it is nice 
frozen or made very cold. 

Stewed tripe if quite tender is relished for a 
change by many invalids, and is very cheap. 

Very ill patients can frequently only take food in 
concentrated forms ; if such be given cold, let it be 
very cold. 

In using ice, be careful where the ice is obtained. 
Children picking up ice near an undertaker's have 
been known to have contracted diphtheria. 

Children of the very poor do not always dis- 
criminate as to their food. Melon rinds and other 
produce of the garbage pails are seized and eaten 
by them with avidity, and sometimes make 



COOKERY FOR THE SICK POOR. II5 

them very ill. Teach the poor that bad food is 
worse than no food. 

The nurse can always keep toasted bread, 
browned crusts for coffee, and such concentrated 
foods as she can obtain, on hand, to carry to her 
invalids. 



APPENDIX. 



INTRODUCTORY. 

The frequent questions about nursing among the 
poorer inhabitants of our cities and towns — which 
questions press all the more closely because of the 
danger that a great epidemic maybe close upon us 
— have led to the publication of this book. In 
addition to the practical suggestions in regard to a 
nurse's own duties, it has been thought desirable to 
give a list of the societies already engaged in similar 
work. They vary in some respects, but are all 
united in the main idea — that nursing \s needed by 
all the sick, whether wealthy or poor, in hospitals or 
outside, and that it is a duty for the well to provide 
for the sick the best nursing that circumstances will 
permit. 

A number of the societies make the instruction 
of the people a first object, that by degrees a better 
understanding of the laws of health and disease may 
spread through all classes. Other societies in- 
sist that the nurse shall in no way seek to influence 

117 



Il8 DISTRICT NURSING. 

the patients either politically or religiously, while 
others make it a chief point '' to carry the gospel of 
Christ to all homes." Some give food, clothing, 
and other help, while others maintain that it is for 
the greatest good of the community if the people 
are expected to supply such wants for themselves, 
or if necessary to obtain them through the regular 
channels for relief Some again think that the 
worthy only should be helped, while one society 
says bravely that it searches out the unworthy, 
striving to teach them '' those things that will be 
for their physical, moral, and spiritual advantage." 

Our largest cities take an interest in this work 
of nursing, and in several of them it is a well- 
established fact, and can no more be abandoned than 
can the large hospitals. Some smaller towns show 
that even with limited means and an extended area 
it is still possible to maintain a District Nurse, while 
at Waltham, Mass., a large training school has 
grown from a system of peripatetic instruction 
given by the physicians to young women willing to 
earn their education by working, at first for the 
needy classes and later by taking private cases 
while still under the direction of their preceptors. 

All information thus far collected goes to show 
that where District Nursing has been thoroughly 
established it has never failed, and it is strongly 
urged that those who can appreciate the comfort of 



APPENDIX. 119 

skilled care in sickness will consider how greatly it 
is needed in homes where poverty or ignorance 
tend constantly to greatly increase the preventable 
miseries of ill-health. 



DISTRICT NURSING AND THE ORGANIZA- 

TION OF SOCIETIES. 

By this general term is known that branch of 
intelligent care for the sick which extends some of 
the benefits of hospital treatment to the poor in 
their own homes. '' Every physician who knows 
about it would be glad to have such nursing for 
every one of his patients, poor as well as rich," 
says a gentleman who has carefully studied the 
subject and has himself established a school, where 
men and women are instructed as professional 
nurses."^ 

In England more than a quarter of a century has 
passed since a determined effort was made to nurse 
the sick poor in their own homes, but in this country 
the oldest associations for the purpose have only 
been at work eight years. The various Catholic 
Sisterhoods and some Protestant Churches min- 
istered to the distressed of all classes long before 

■^ " The Training Schools of the Future." By Dr. Edward Cowles, 
Superintendent of the McLean Asylum, Somerville, Mass. 



I20 DISTRICT NURSING. 

this time, but their effort was limited by other 
duties, and could, therefore, never become general. 
With the increased interest of modern times in the 
well being of those about us, with the knowledge 
that the illness or filth-of one portion means danger 
to the whole community, comes a desire to care for 
the sick, to insist on sanitary precautions, and to 
consider the best and most economical methods for 
the maintenance of the public health. 

The first idea of those who have not looked 
deeply into the subject, is that the poor should 
avail themselves of the numerous hospitals which 
are to be found in all our large cities, but even 
were they of twice their present capacity, they 
could not receive all of the sick. Then, too, is 
separation from home necessary or advantageous 
in every case ? A mother with a family of little 
ones would far rather stay with them, even if she 
must remain ten days in bed, than to break up the 
establishment or entrust it to strangers for that 
period. A consumptive, seeing before him, in the 
intervals of depression which are mingled with hope 
in this disease, only one end to his long suffering, 
clings to his home and dreads the depressing sights 
of a hospital. In many instances a mother will 
endure all sorts of poverty and privation rather 
than part from a sick child. These are a few of the 
instances where the people will not accept hospital 



APPENDIX. 121 

care but there are also many cases when hospitals 
cannot admit those in need of attention. The poor 
" chronics " belong especially to this class. 

To the sick outside of hospitals the District or 
Visiting Nurse devotes herself and if she loves her 
work she can see on all sides the blessing that it 
carries; nowhere else is the direct effect of charity 
so visible. The tired, uncomfortable patient is 
soothed, bathed, and laid amid clean surroundings, 
the room is made tidy, the attendants urged to 
more systematic care and a suitable diet suggested, 
the latter sometim.es even provided by the nurse if 
it appears necessary to her. 

Of the various systems for district nursing pre- 
vailing in this country, those of chief interest can 
perhaps be best shown by a rather detailed account 
of the methods used in Boston and Philadelphia, 
those in other cities resembling one or the other in 
a greater or lesser degree, according to the local 
arrangements and the views of the managers. 

The Instructive District Nursing Associa- 
tion OF Boston. — In Boston the city is divided 
into districts, a nurse being assigned to each by 
the Instructive District Nursing Association, which 
also details two of its managers to supervise the 
work of each nurse. At first only a few such 
districts were undertaken but as the means have 
been supplied new ones have been added, two 
9 



122 DISTRICT NURSING. 

managers being elected with each. The last 
printed report (for the year ending January 30, 
1892) shows seven such "district committees;" 
another was added in 1892 and it is hoped that 
early in 1893 there will be yet another; possibly 
all the dispensary districts, of which there are ten, 
will have nurses this year. There is also a '' nurse 
at large " for cases that do not belong to the 
Dispensary. This society has admirable arrange- 
ments for its loan supplies, and its system of 
instruction to those about a patient is most valuable 
as an educational movement. To quote from its 
last report : " The Instructive District Nursing 
Association, organized in 1886, provides and sup- 
ports nurses, duly certified by some w^ell-known 
training school, who, acting under the immediate 
direction of the out-patient physicians of the Boston 
Dispensary, care for the sick poor in their own 
homes instead of in hospitals. As an integral part 
of their service the District Nurses are required to 
instruct the families they visit, by example and by 
precept, to take better care of themselves and their 
neighbors, to promote their own welfare and the 
public health by obeying the laws of wholesome 
living and by practicing the simpler arts of domestic 
nursing. This work is intended to supplement, 
not to duplicate, the proper function of hospitals ; 
ordinarily only those cases are attended which the 



APPENDIX. 123 

hospitals do not receive. Special nurses are sup- 
plied on the request of any physician of standing, 
according to the formula upon a postal card, which 
may be procured from the agent of the Associa- 
tion, who is in daily attendance at the office from 
9 A. M. until 2 p. M." 

'' The nurses receive ^40 per month during the 
three months' probation, and then ^45 per month ; 
after two years' service the salary is ;^50 per month. 
In addition, each nurse is allowed $4 per month 
for car fares and $2 per month for charwoman 
and the necessary washing for patients ; also one 
month's vacation without loss of pay, a substitute 
at 1^40 per month being provided. A new nurse 
may thus cost the Association ^637, and one two 
years in service $^12. Besides the nurses' salaries 
there are the running expenses of the Association, 
including rent, supplies and the agent's salary, the 
rent for a room in Park Building for the use of the 
Board of Managers and agent and for two rooms — 
one at the North End and one at South Boston — 
where the supplies are kept and where the nurses 
rest at noon." 

The Visiting Nurse Society of Philadelphia. 
— The name of this organization shows that it 
differs from those preceding in its original plan of 
work. The districts are not considered, but the 
cases are divided according to their nature. The 



124 DISTRICT NURSING. 

nurses attending maternity patients do not take 
general surgical work. One whose care is for 
cancer does not dress other open wounds, etc. 
This division of the labor, of course, entails more 
trouble and expense, for in a large city the car 
fares are a very heavy item and the time taken in 
the long rides is greatly to be deplored ; still, the 
theory of preventing the spread of disease is para- 
mount and for this reason all infectious cases are 
refused. The nurse must tend her patients so 
much more closely than a doctor does that she is 
more likely to carry away germs in her clothing 
and the first rule of this Society is, therefore, to 
** run no risks." It is not usual in American 
district nursing to include maternity cases but it 
has been found in this city a most useful branch, 
the results being especially satisfactory in the health 
of the mothers after confinement. 

In Philadelphia the nurses are paid salaries, 
which do not include board, as that is furnished in 
the home provided. In this home the nurses sleep, 
and to it they return for their meals, the whole 
being under the charge of the Head Nurse or 
Superintendent. Some of the nurses have been 
fully trained to hospital service, some are pupils 
learning general practice under the Head Nurse, 
after some special or accidental training. 



APPENDIX. 125 

To satisfactory pupils a certificate is granted at 
the end of the term of service. 

These nurses visit patients of all degrees of social 
standing, the very poor being attended gratis and 
others paying according to their ability. Often a 
physician needs a nurse for an office examination, 
or a patient confined to bed desires a bath or some 
other occasional attention, which those about her 
are unable to give, and for which she does not 
desire to retain the services of a permanent nurse, 
but for which she can fully pay. When the general 
work of the Society will permit, the pupil nurses 
can remain a short time, a few days or a week, with 
a patient of moderate means, the charge in such a 
case only slightly exceeding the salary paid to the 
nurse. 

The total expense for one year (ending Feb- 
ruary 29, 1892) was $4474.22, or, deducting the 
share borne by the patients, ;^3673.28.'^ 

The expenses will be materially diminished for 
the next year by the loan of a house (1340 Lom- 
bard Street) rent free, which has recently been 
offered to the Society. In Philadelphia the plan of 
having a house for the nurses was found essential, 



* The exact cost of a nurse cannot be given here, as the pupil 
nurses receive but a small salary at first, their pay increasing with their 
usefulness. The trained nurses receive twenty-five dollars a month 
besides board and washing. 



1 26 DISTRICT NURSING. 

as their individual homes were far removed from 
their work and it was hard to secure them a com- 
fortable mid-day meal. By this plan, also, the 
cases come under the frequent supervision of the 
Head Nurse, while the office, which is always 
open, encourages doctors and friends of the patients 
to call to leave necessary directions. There is at 
this office a small registration bureau for nurses 
willing to accept low fees. For these ** outside 
nurses " the Society is not responsible, although it 
does what it can to secure reliable women. While 
the chief work of the Society and its nurses is to 
secure' good home nursing for the sick, yet atten- 
tion is also given to other needs, it being the rule 
that no patient must suffer if relief can be found. 
There cannot be good nursing if there is no food 
nor fire nor bedding. Nourishment is sent in 
generous quantities to the office, and from thence 
carried by the nurses to those who need it. The 
Charity Organization Society and other benevolent 
associations are asked to help, or, if the case is one 
where entire destitution, absolutely unhealthy sur- 
rounding, or other causes make proper home care 
impossible, every effort is made to place the patient 
in a hospital or home. 

The classification, the searching for other modes 
of relief, the placing in hospitals, the caring for 
child as well as mother in maternity work, and the 



APPENDIX. 127 

distances to be daily traversed in so large a city, 
all tend to restrict the number of visits paid, but it 
has been considered that the ultimate good is 
increased by this useful, though unrecorded labor. 
The Society can only hope that its larger house 
and its lessened living expenses will now enable it 
to increase its force of workers, thereby reducing 
the proportional cost of each patient. 



LIST OF ASSOCIATIONS FOR THE CARE OF 
THE SICK NOT IN HOSPITALS. 

BOSTON. 

The Instructive District Nursing Association, Room 64, 
No. 2 Park Square, Boston. President, Miss Phebe Adam ; Sec- 
retary, Mrs. W. T. Sedgwick ; Treasurer, Mrs. Otis Norcross.* 

Tts object is caring for the sick poor at their homes, the in- 
struction of the families visited in domestic nursing and in the 
laws of wholesome living. It was founded in 1886. Total cases 
for one year, 3122. The visits paid were 37,188, besides 28 whole 
days and 35^ whole nights. Eight nurses were employed. The 
patients pay nothing for the service. The nurses are under the 
immediate direction of the out-patient physicians of the Boston 
Dispensary. The Association gives no help except in nursing, but 
will lend various articles useful in sickness, and co-operate with 
other charities for the relief of suffering. The nurses visit all 
classes of ca?es, except normal confinements. After attending con- 
tagious diseases they are limited in regard to other patients, are 
required to change clothing and use means of disinfection. 

* Report for the year ending January 31, 1892. 



128 DISTRICT NURSING. . 

The New England Deaconess Home and Training School 
45 East Chester Park, Boston — Rev. W. N. Brodbeck, President 
Mrs. E. H. Watkins, Secretary ; Mrs. J. W. Cashing, Treasurer — 
has for its objects the training of young women for Christian work, 
and the assistance of deaconesses to all " who need either physical 
or spiritual help." Last year 2387 hours were spent in nursing, 
and 10,494 calls were made. The Home was founded November 
20, 1889. There are two nurses, but the other workers nurse 
occasionally. The patients do not often pay, but are expected to 
do so if they are able. The nurses are called by a physician of 
either school of medicine, also by friends of the patients. 5019 
garments were given last year to the needy, 278 baskets of food 
and ^122.40 worth of fuel. The nurses attend all cases, except 
those of a decidedly contagious character. It is hoped a hospital 
may be built before long when this work will be enlarged and the 
nurses trained for district cases. 

Nursing is one of the duties of the Friendly Society of the 
South Congregational Church (Dr. E. E. Hale's), corner 
Newbury and Exeter Streets, Boston. Mrs. J. W. Andrews, Presi- 
dent; Mrs. M. S. Childs, Secretary; Miss E. M. Eustis, Treasurer. 

The objects of the Society are to care f jr the sick and poor of its 
di-^tricts, to aid other charitable objects and to extend the hospitali- 
ties of the church. It was founded March 13, 1833 ^^^ engaged 
a nurse in 1881. The cases average 200 annually, the nurse's visits 
nearly 1700. Only one nurse is employed. The patients do not 
pay for the service and the nurse is at the call of the sick within 
the district taken by the church. She can give food and clothing 
if needed; clothing is also loaned to the sick. She takes no very 
sick cases. As her name implies, she enters the homes as a friend, 
teaches the inmates how to care for each other, how to prevent a 
cold turning into a fever, etc. She works on the principle that " an 
ounce of prevention is worth a pound of cure." 



APPENDIX. 129 

NEW YORK. 

In New York the work is undertaken by The Woman's Branch 
OF The New York City Mission and Tract Society, 401 United 
Charities Building. Mrs. M. K. Jesup, First Directress , Miss M. 
E. Mitchell, Treasurer ; Mrs. R. M. Field, Secretary. Its object, 
in addition to its chief work, which is missionary, is '* to minister 
to the sick poor, providing things necessary for their recovery in 
their homes or removing them to hospitals if necessary." The 
Society was established in 1822. Its report, dated December, 1877, 
says : *' A new power for good has been introduced this year, the 
Missionary Nurse. Prepared in the Training School she is thor- 
oughly competent to do all that is necessary in cases of extreme 
illness and has been an unspeakable comfort to many who have 
had no one to minister to them." 

The nurses' cases numbered in 1891, 1260; in 1892, 1127. 

It has from five to nine nurses at work, but tlie patients pay noth- 
ing. The nurses " call on any needy person in their district, New 
York below Fourteenth Street." They give both spiritual and tem- 
poral help, the latter including food, necessary clothing and occa- 
sional loans. They have a large number of maternity and a few 
fever cases. Surgical cases are generally sent to a hospital. 

The District Nursing Section of the United Relief Works 
(Society for Ethical Culture) seems to have no address of its 
own but can be reached through its officers — Leo G. Rosenblat, 
President; Louis Seligsberg, I021 Park Avenue, Secretary; Pro- 
fessor Felix Adler, 123 E. Sixtieth Street, Treasurer. The object 
is '' Remedial Charity," to nurse the sick poor in their own homes 
under visiting physicians' orders, also to teach proper care, diet, 
etc. This work w^as begun in 1878. The chief nurse paid 2800 
visits in 1892. Two nurses are now employed. Formerly there were 
five, but three are taken by the Dispensary and paid by it. The 
patients never pay for the service. Each nurse is attached to a 
dispensary, can act only under the doctor's orders and only in 
her own district. They give all the help needed by their patients, 



130 DISTRICT NURSING. 

except scrubbing, cleaning, etc., for which they can engage assist- 
ance. They care for all kinds of illness. 

These nurses have a fund with which to assist needy cases, to give 
food, help, stimulants, etc. The Sewing Society of the Society 
for Ethical Culture provides bed-linen, night-clothing, baby out- 
fits and shirts of all kinds. At Christmas and Thanksgiving an 
extra fund is supplied and in summer the sick children are sent to 
the country by private aid or by the '* P>esh Air Fund." 

The Red Cross Society in Brooklyn, N. Y., has its office 
at 195 Montague Street. H. Beeckman Delatour, M. D., President; 
Miss Clara Matthews, Secretary; Mrs. Marion Bowen, Treasurer. 

Its special objects are : 1st. "To teach ready methods of rendering 
temporary aid to the sick and injured." 2d. "To give instruction in 
house nursing and the laws of health." The district nursing part 
of the work has been in operation for three years but is not yet 
quite organized as it is intended to be. There is thus far one nurse 
who responds to the call of any sick person in Brooklyn, taking all 
sorts of cases, obstetrical, contagious and everything, so far as her 
strength will permit. 

PHILADELPHIA. 

The Visiting Nurse Society. — The Visiting Nurse Society, 
1203 Race Street (to remove June i, 1893, to 1340 Lombard 
Street). Mrs. Henry C. Lea, President; Miss Mary Moss, Secre- 
tary ; Miss Maria Hopper, Treasurer. Its object is to give to the 
poor and to those of moderate means the best home nursing possible 
under existing circumstances. It was founded in 1886. Total 
cases for one year 612, visits paid 7464. The number of nurses 
varied at different times, but there was an average of five at work. 
The service is free to the very poor ; other patients pay according to 
their means; the receipts from this source amounted to ^800.94.*^ 

The nurses are at the call of all needing them, and during this 
year worked under 209 different physicians, representing both 

■^ Report for the year ending February 29, 1892. 



APPENDIX. 131 

schools of medicine. The Society promises no help except nursing, 
but its nurses gladly distribute nourishing food to the patients, 
which is often provided by those interested. The cases undertaken 
consist of all, including maternity, except those of a decidedly con- 
tagious character. 

The Philadelphia Dispensary, 127 South Fifth Street, Dr. 
Thomas Wister, Secretary. Its object is medical relief of the 
worthy poor. It was founded in 1876, but has only employed a 
nurse for about three years. It has about 25,000 cases annually, of 
which six hundred are confinements. It has one nurse, *' who 
shall visit every lying-in case and attend to the wants of the mother 
and child under the direction of the physician in charge." The 
patients pay nothing. The nurse can only be called by a physi- 
cian belonging 10 the Dispensary. She gives no help except nurs- 
ing (unless food or clothing has been sent her for distribution) and 
attends only maternity cases. 

District nursing is undertaken by the Mary J. Drexel Home 
AND Mother House of Deaconesses, 2100 South College Avenue, 
the officers in charge being Sister Superior Wanda Von Oertzen ; 
Rev. Blum pro tempore. The deaconesses' labors embrace all 
kinds of charitable works, one of them being district nursing and 
assisting the poor. The parish work was commenced in 1 890 in 
St. Paul's and Zion Lutheran congregations and comprises visits 
to the sick 1200; visits to the poor 144; night watches 50. There 
is one nurse in each parish (St. Paul and Zion). 

The sisters are not allowed to take anything from the patients, 
neither money nor presents. The parish sisters are trained in the 
German Hospital but are attached to the Mary J. Drexel Home 
and sent out from it. They are bound by contract to the con- 
gregation which pays the Mother House a certain sum to maintain 
each sister. The parish sister is under the special superintendence 
of the clergyman also at the disposal of the Ladies' Aid Society. 
She is at the call of every person in the parish. They do all work 
needed in a family, such as cleaning rooms, washing, cooking, 
dressing and taking care of the children, but only when the mother 



132 DISTRICT NURSING. 

is sick or dead and no other person is at hand. The nurses attend 
all cases, especially contagious ones, as it has been found that such 
are particularly neglected. Patients needing hospital care (exclud- 
ing contagious diseases and maternity cases) are sent to the German 
Hospital or to the Children's Hospital of the Mary J. Drexel Home, 
both of which are under the care of sisters. 



BALTIMORE. 

The Deaconesses of the Home Missionary Society of 
THE Methodist Episcopal Church, 2013 East Pratt Street, 
visit the sick and expect to have a graduate nurse before long to 
assist in the w^ork. They maintain that *' it is impossible to do 
much for the soul until the body is made as comfortable as possible." 
They go to the rich and poor alike, regardless of disease, but are 
not paid for their service ; if a patient offers remuneration it is put 
aside for the use of the poor. 1200 visits were made last year, but 
not more than a quarter of these for nursing, the greater part of 
which was in summer. They often carry diet, clothing, and bed- 
linen; the latter is sometimes given, sometimes loaned. Sick room 
appliances are also furnished by them. There is no hospital or 
dispensary connected with this organization. 

Another society in Baltimore is called The District Nursing 
System, 321 N. Paca Street; O. Edw. Janney, M. D., is in charge. 
Its object is " to supply nursing to the poor at their homes." It was 
founded October i, 1892, and has about twenty cases a month. It 
employs one nurse and "the patients are expected to pay what they 
can." The nurse is not attached to any hospital or dispensary, but 
is at the call of all persons needing her ; she gives food and neces- 
sary clothing and attends all cases, except those that are contagious. 

The Evening Dispensary for Working Women and Chil- 
dren, 614 South Charles Street, is making a tentative effort in 
regard to district nursing but has by no means decided to undertake 
the work. The Dispensary is managed by a committee of five lay 
and two medical members, Miss K. M. McLane, President; Miss J. 



APPENDIX. 133 

R. Rogers, Secretary and Treasurer. Since July, 1892 one nurse 
has been employed by the Dispensary to be present at the afternoon 
and evening clinics (four evenings, two afternoons) and to visit 
such cases as the medical staff of the Dispensary (all women) are 
prepared to undertake. The recent average of visits paid by this 
nurse is six per day. The patients are not charged for the nurse. 
There is no regular help given except medical care but when 
clothing is sent it is distributed to the most needy. All cases are 
thus far accepted, except the contagious. The nurse has her room 
at the Dispensary and sleeps there. 

CHICAGO. 

The Visiting Nurse Association of Chicago has an office 
open from 9 A. M. to 12.30 p. M. daily, at Masonic Temple, Room 1 1 , 
16 State Street. 

The officers are Mrs. E. C. Dudley, President, 1 6 19 Indiana 
Avenue; Mrs. Hermon B. Butler, Secretary; Mrs. Wm. T. Con- 
ger, Treasurer. *' This Association is formed for the benefit and 
assistance of those otherwise unable to secure skilled attendance in 
time of illness, to promote cleanliness and to teach proper care of 
the sick and to establish and maintain one or more hospitals for 
the sick, or a home or homes for the accommodation of nurses." It 
was organized in 1 889. 

In 1891 total number of patients, i>407 

"visits, 13439 

In 1S92 '' " " patients, 2,478 

" " " " visits, 17,346 

Nine nurses are now employed, one of these being a head nurse. 
From the very poor no pay is expected. Occasionally a patient is 
able to give something to the Association. No nurse is paid by the 
patients. 

The nurses are at the call of any one needing them, the Associa- 
tion being independent. The nurses distribute old clothing, food, 
beef teas, condensed milk, milk tickets, malt, cod-liver oil, etc. 
They attend every kind of case, fevers, maternity, surgical, except 



134 DISTRICT NURSING. 

the well-known contagious diseases, small-pox, scarlet fever, and 
diphtheria; to those a special nurse is sent. 



NEWPORT, R. I. 

For the past two years, since Feburary 15, 1890, a trained 
nurse has been employed in Newport, Rhode Island, for district 
nursing among the poor. She is under the superintendence of the 
Secretary of the Charity Organization Society. The nurse reports 
daily to Mrs. Curtis at the rooms of the Charity Organization 
Society and receives any special directions and supplies through 
her. No money passes through the nurse's hands but she is allowed 
to take small comforts to the very poor and to prepare simple food 
for them at their own houses. 

During the past year, 1892, she has had 152 patients and made 
1987 visits; about two-thirds of the cases are confinements, the 
remainder including all kinds of diseases not contagious. She also 
assists the doctors when necessary in surgical cases. Patients able 
to pay are charged thirty cents an hour for the services of the nurse, 
and the money so raised is spent in food for the very poor. About 
^12 was the amount paid by patients last year. The very poor 
always have the preference when the nurse is pressed for time. The 
Charity Organization Society has on hand a good supply of clothing, 
beddingj etc. and a cot-bed, mattress and pillows, which are loaned 
to the nurse's patients when necessary and returned to the Organi- 
zation when the emergency passes. The Overseers of the Poor, 
acting in harmony with the Organization, have also kindly provided 
her with blank orders which enable her to supply many small com- 
forts when needed. The nurse has a tricycle at her disposal and 
finds it extremely convenient. 

Bedding, baby outfits, etc., including the cot, mattress and pil- 
lows, have been furnished by a little society of poor girls, a branch 
of the Working Girls' Club, who meet every week to sew for charity 
and save their pennies for the same purpose. They give the work, 
the ladies most of the materials, not all. 



APPENDIX. 135 

BUFFALO, N. Y. 

The District Nursing Association, 65 Franklin Street, Buf- 
falo, N. Y., has for its officers Miss Mary A. Lewis, President; Mr. 
Charles D. Marshall, Treasurer, and Mrs. Bernard Barton, Secre- 
tary. It object is to provide free nursing for the sick poor. It was 
founded in 1885 and attends between 400 and 500 cases annually, 
having three nurses and giving the service without charge. The 
nurses are at the call of any doctor, the friends of the patients, and 
the agents of the various charitable societies. They give tickets 
for food from the diet kitchen and also carry nourishment and 
various articles for the comfort of their patients; they attend all 
cases, only excepting those known to be able to pay for the service 
of an attendant, confinement cases where a midwife is engaged, 
and those of a positively malignant character. 

ROCHESTER, N. Y. 

In Rochester, N. Y., the "Margaret Harper Nurse" is con- 
nected with the Rochester Homoeopathic Hospital ; her support is 
given annually by the payment of $300 as a memorial, by her 
daughter, to Mrs. Fletcher Harper. The work was begun in 1890, 
and its special object is visiting among the sick poor of the city. In 
the past year the nurse made 747 visits, 3 1 being maternity cases. 
The Margaret Harper Nurse is from the class belonging to the 
Training School connected with the hospital, twelve nurses serving 
during the year, each having one month. This is considered one 
of the most valuable parts of the lessons received during the two 
years' course. No remuneration is received from any patient, and 
the nurse is at the call of any who need her. There is a fund from 
which the nurse may provide anything absolutely necessary, such as 
food, clothing, etc. All cases are attended, calls being as much 
from the Allopathic as from the Homoeopathic school. 



136 DISTRICT NURSING. 



HAMPTON, VA. 

District nursing is a feature of the Hampton Training School 
FOR Nurses, at Hampton, Va. Dr. S. K. Towie, of the National 
Soldiers' Home, Va., is the President ; Miss A. M. Bacon of the 
Normal School, at Hampton, is Secretary. The object of the School 
is to train colored nurses for missionary, hospital or private nursing. 
The first nurses were taken in June, 1891. Since October, 1892, 
about 45 cases have been cared for by the District Nurses and about 
150 visits paid (February, 1893). There are ten student nurses; of 
these any may be detailed at any time for district work. The 
patients do not pay for the service. The nurses are all attached to 
the Dixie Hospital and Hampton Training School but respond to 
every outside call as far as is possible. They often give help by 
carrying special diet, clean bed-clothing or other necessaries from 
the hospital to the patients' homes. They attend all classes of cases, 
although the first year nurses do not go to the contagious ones, as 
they must return daily to the hospital for lectures. 

ROXBURY, MASSACHUSETTS. 

The Society for Relieving the Sick Poor in Roxrury, 
Rooms of the Roxbury Charitable Society. Mrs. James Guild, 
President ; Mrs. Wm. C. Williams, Treasurer ; Miss Elizabeth 
Huntington, Secretary. The object is nursing with instruction. 
The work was started in 1888. Between 200 and 300 new patients 
are attended yearly and from 1200 to 1300 visits paid. There is 
only one nurse and the patients pay nothing for the service. The 
nurse is at the call of doctors of any school of medicine or of any 
person needing her. She lends necessary clothing and sick-room 
appliances as far as her stores will permit and can give diet of 
milk or eggs on the order of the physician in charge of the case. 
She can attend all persons not able to pay for a nurse but does not 
take maternity work unless at leisure from other calls. In visiting 



APPENDIX. 137 

contagious diseases she is required to change her clothing and use 
means of disinfection before visiting other patients. 



WALTHAM, MASS. 

In Waltham, ^lassachusetts, district nursing is done by the 
Waltham Training School for Nurses, rear of 716 Main 
Street. A. Worcester, M. D. President ; Miss S. M. Wellington, 
Treasurer. The objects of the School are, " to supply trained 
nurses to the community at moderate prices or gratuitously and to 
train young women to a noble profession." It was started in the 
spring of 1885, and has between iioo and 1200 cases annually, 
the nurse remaining twenty- four hours or more; it has also 1800 or 
1900 call cases where the nurse pays an average of six or seven 
visits to each. There are from thirty to forty nurses. The patients 
pay for the service if possible but if very poor no charge is made. 

In the first year in the School the nurses are sent only to families 
where one of the physicians connected with the School is in charge, 
as much of a nurse's instruction is received at the patient's bedside. 
In the second year the nurses go wherever they are needed, in town 
or out, and supply the Waltham Hospital with nurses, although the 
Training School is not attached to the Hospital in any way. They 
do not as a regular thing give any help except nursing, but they are 
taught to make themselves generally useful in the families where 
they nurse, and this often entails cookery and other housework not 
strictly for the patient. They are often the medium through which 
food and clothing are given to the poor. They attend all cases 
except contagious ones out of town. 

NEW HAVEN, CONN. 

In New Haven, Connecticut, there is no regular district nursing, 

but where the Training School of the State Hospital receives 

contributions for missionary work, it will, if possible, send an 

*' Externe," that is, a nurse who is having some months of private 

10 



138 DISTRICT NURSING. 

practice before she receives her diploma. Nurses cannot under- 
take contagious cases, and are (to the great regret of those in charge of 
the Hospital) unable to accept many free cases, as the support of 
the Training School depends upon the money earned through the 
'* Externes." 

NORWICH, CONNECTICUT. 

Visiting Nurse Department of the United Workers of 
Norwich. Miss Eliza P. Perkins, N. Washington Street, Chair- 
man of Nurse Committee. Its object is to *' give the best home 
nursing possible under existing circumstances." The first nurse was 
employed in 1887. The number of patients in 1892 was 126, and 
in January, 1893 the one nurse employed paid over 200 visits. 
The patients pay nothing and the nurse is called by physicians of 
either school of medicine or by friends of the patients. The nurse 
gives diet when it is sent her for distribution and can also have 
soup made once or twice a week at the United Workers' House. 
She attends all cases except those of a decidedly contagious char- 
acter. Her difficulties are greatly increased by the remoteness of 
her patients. She goes the length and breadth of the town, using 
cars where she -can, and, when she must, the carriage of the city 
missionary. 

WILMINGTON, DELAWARE. 

The Associated Charities of Wilmington, Delaware, 837 
Tatnall Street, Mrs. A. T. Clark, Superintendent, will in some 
cases provide a nurse for out-patients through co-operation with the 
city hospitals which will lend a nurse when not too busy. The 
Society provides sick diet for the patients in their own homes and 
will assist them to enter hospitals when necessary. 

KANSAS CITY, MISSOURI. 

In Kansas City, Missouri, The Instructive Nursing Associa- 
TION, 723 East Ninth Street, has for its officers Mrs. Henry Van 
Brunt, President; Mrs. Frank Simpson, Treasurer; Miss E. B. 



APPENDIX. 139 

Allen, Secretary. The object of this Association is " to provide vis- 
iting nurses to those otherwise unable to secure skilled attendance 
in illness, and to teach cleanliness and the proper care of the sick." 
It was founded April 4, 1 891, and during the first part of the year 
146 cases v^ere attended, 2258 visits paid. One regular nurse is 
employed and assistants as needed. When charity patients do not 
occupy the nurse's time fully she is permitted to visit those who pay. 
She is at the call of any one who needs her. She gives nourishing 
food and lends garments. She attends all cases save those of con- 
tagious diseases and for them a special nurse is provided. 



ENGLAND. 

Of district nursing abroad little can be said within the limits of 
this work. It is undertaken in many, if not all, of the larger towns 
in England, having been established there for over twenty-five years. 
In Manchester, England, the District Nursing staff consists of 29 
nurses, residing in three Homes, each under the supervision of a 
matron. Each nurse is allotted to a certain district ; she can give 
medical necessaries and comforts and lend medical appliances ; she 
attends the sick free of charge, but those who are able are encouraged 
to give a small sum as a thank-offering. Any one may send notice 
of a case of sickness to the matron of the nearest Home. The 
Society derives its support from a general fund made up from sub- 
scriptions, legacies, the Hospital Sunday and Saturday Grant, etc., 
but as this sum is not sufficient, each home must secure a supple- 
mentary income by subscriptions through the members of its own 
committee. There is also a " Good Service Fund" for the nurses, 
supported by special donations, etc. At present, one nurse is receiv- 
ing a pension from this fund after twenty-six years' service. The 
name of this Society is the Manchester and Salford Sick Poor,. 
AND Private Nursing Institution. As its name implies, one 
branch of its work is supplying nurses to private cases. From this 
branch some revenue is received which helps the charity work. The 
Institution was founded in 1864. 



140 DISTRICT NURSING. 

The sixth annual report of the Southport and Birkdale 
District Nursing Society was presented the first of this year 
(1893), and shows four nurses at work, one of them being a midwife. 
There is no home, only a room at No. 4 Stanley Street, Southport : 
each nurse has her own address given on the Society's report. The 
work is that of the ordinary District Nurse, and some instruction is 
given to the friends of the patients. 

The Liverpool Training School and Home for Nurses, 
Ashton Street, Liverpool, is a large organization under the charge 
of a " Lady Superintendent and Assistant Lady Superintendent." 
Its objects are: — 

The training of nurses for hospitals (Royal Infirmary attached). 
The training of nurses for private families. The training of nurses 
for attendance on the sick poor in their homes. 

It was founded in 1862. The cases attended in the districts range 
from 3000 to 3500 annually, with over 90,000 visits. There are 
twenty nurses distributed over the city, which is divided into twenty 
districts. They are lodged in four houses, N., E., S,, W., and each 
house is under the charge of a District Matron who is herself fully 
trained and who follows her nurses in their district v/ork to super- 
vise and direct it.-^ The patients pay nothing for the service. No 
relief is given except medical comforts, etc. No infectious or 
maternity cases are taken. 

The East London Nursing Society, office No. 49 Philpot Street, 
Commercial Road, London, E., is doing a large work, but, unfor- 
tunately, cannot be spoken of in detail, as no report has been received. 

There are also other societies in the United wStates and Canada, 
but their replies to the series of questions asked have not been 
received in time for classification. 



The writer extends most hearty thanks to all the friends to 
District Nursing who have so wilUngly given the data required to 
compile this list, and hopes most earnestly that the work may spread 
until every town and neighborhood can have its friendly visiting 
nurse. 



INDEX. 



Addresses, of doctors, 47. 

" charitable institutions, 47. 
Ambulance service, 49. 
Apoplexy, 57. 
Appeals to the public, 22. 
Appendix, 117. 
Asphyxia, 57. 

Assistance in case of need, 27. 
Associations for the sick not in hospitals, 



Bed sores, 59. 
Beef juice, 114. 
Books for reference, 44. 
Bones, fractured, 50, 51. 

" dislocated, 52. 
Brain, concussion of, 55. 

" compression of, 55. 
Burns, 55. 
Buttermilk, 113. 
Clothing of the nurse, 37. 
Cheese, cottage, 114. 



127. 

Boston, 121, 127. 
Baltimore, 132. 
Chicago, 133. 
England, 139. 
Hampton, Va., 136, 
Kansas City, Mo., 138. 
New Haven, Ct., 137. 
Newport, R. I., 134. 
New York City, 129. 
Norwich, Ct., 138. 
Philadelphia, 124, 130. 
Roxbury, Mass., 136. 
Rochester, N. Y., 135. 
Waltham, Mass., 118,137. 
Wilmington, Del., 138. 



141 



142 INDEX. 

Chicken-pox, 81. 
Children, sick, 66-74. 

*' rachitic, 77. 

" specific disorders in, 77. 

" with whooping-cough, 77. 

" with croup, 78. 

'* with infantile paralysis, 78. 

*' with skin disease, 79. 

" dentition of, 76. 
Choking, 58. 
Chronic invalids, 28, 88. 
Conditions to be met, 18. 
Contusions, 52. 

Contagious diseases, 28,41, 80, 81, 82, 87. 
Convulsions, 58, 74. 
Cookery, for the sick poor, 109. 
Curds and whey, 112. 
Diet, special, iii. 
Diphtheria, 80. 
Dislocations, 52. 
District nursing, 9, 17, 18, 22, 117, 119. 

" nurse, 9, 10, 11, 13, 16, 26, 27, 29, ^6, 37. 
Druggists, should be known by nurse, 26. 
Drowning, 56. 

Ear, foreign substances in, 58. 
Eggs, 113. 
Emergencies, 49, 50. 
Epilepsy, 56. 
Fever nursing, 93-100. 
Food supplies, 21, 77. 
" for infants, 75. 
" of children, 114. 
*' concentrated, 115. 
Frostbite, 55. 

Fuller ton, Anna, 3L, M. D., 59. 
General supplies, 46. 
Gruel, 113. 
Hands, care of, 40. 
Half measures futile, -34. 
Headquarters of the nurse, 45. 
Heat stroke, 56. 
Hemorrhage, 53, 54. 
Homes of the poor, 21, 29. 



INDEX. 143 

Hospitals, a prejudice against, 26. 

" insufficient in number, 120. 

Hygiene teaching, 24, 105, 108. 
Hysteria, 56. 
Ice, 114. 

Infant feeding, 75. 
Infectious diseases, 84, 85. 
Intoxication, 56. 
Introductory, 9. 
Invalids, the peripatetic, 28. 

" partial, 32. 
Koumiss, 112. 
Landlord and tenant, 20. 
Laundry work, 78 
Lectures, 48, 105. 

Legal measures for protecting public health, 21. 
List of personal supplies, 42. 
" general " 46. 
Loan fund, 91. 
Lockjaw, 53. 
Measles, 81. 

Medical nursing, SS, 90, 91. 
Methods of work, 25. 
Milk, sterilized, 112. 

'* warm, 112. 
Mothers, young, 56. 
Nuisances, to be reported, 25. 
Office of nurse, 27. 
Obstetrical emergencies, 59. 

^' nursing, loi, 103. 
Operations, 62. 
Outfit of nurse, 35, 36. 
Pauperizing the poor, 30. 
Philanthropic work, ^^. 
Poisons, 58. 
Porridge, 113. 
Poverty, depressing, 14. 
Rent, payment of during illness, 20. 
Records of the nurse, 27. 
Salt, 113. 
Scarlet fever, 80. 
Shock, 55. 
Societies engaged in district work, 117, 121, 127, 129, 130, 140. 



144 INDEX. 

Soup, 113. 

Sprains, 52. 
Supplies, general, 45. 

" personal, 42. 
Surgical nursing, 61, 65. 
Syncope, 56. 

Teaching in the home, 104, 1 08. 
Tracheotomy, 65. 

Training school at Waltham, Mass., 1 18, 137. 
Union, the strength of, 27. 
Water, 112. 

Wood, Miss Catherine, 68. 
Wounds, 52, 53. 



CATALOGUE No. 7. APRIL, 1893. 

A CATALOGUE 

OF 

BOOKS FOR Students. 

INCLUDING THE 

? QUIZ-COMPENDS ? 





CONTENTS. 




PAGE 


PAGE 


New Series of Manuals. 2.^,4, "^ 


Obstetrics 10 


Anatomy, 


. . 6 


Pathology, Histology, . .11 


Biology, 


. II 


Pharmacy, . . . .12 


Chemistry, . 


. 6 


Physical Diagnosis, . . 11 


Children's Diseases, . 


. 7 


Physiology, . . . .11 


Dentistry, 


. 8 


Practice of Medicine, . 11, 12 


Dictionaries, 


8, 16 


Prescription Books, . . 12 


Eye Diseases, 


. 8 


?Quiz-Compends ? . 14,15 


Electricity'-, . 


• 9 


Skin Diseases, . . .12 


Gynaecology, 


. 10 


Surgery and Bandaging, . 13 


Hygiene, 


• 9 


Therapeutics, , . .9 


Materia Medica, . 


• 9 


Jrine and Urinary Organs, 13 


Medical Jurisprudence 


. ID 


Venereal Diseases, . . 13. 


Nervous Diseases, 


. ID 






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preparation of candidates for examination, and their subsequent 
professional career, may be relied upon to have carried out his 
work successfully. Without following out in detail his arrange- 
ment, which is excellent, we can at once say that his book is an 
embodiment of modern ideas neatly strung together, with an amount 
of careful organization well suited to the candidate, and, indeed, to 
the practitioner." — British Medical Journal. 

Price of each Book, Cloth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 2. DISEASES OF V70MEN. 150 lUus. 

NEW EDITION. 

The Diseases of Women. Including Diseases of the 
Bladder and Urethra. By Dr. F. Winckel, Professor 
of Gynsecology and Director of the Royal University 
Clinic for Women, in Munich. Second Edition. Re- 
vised and Edited by Theophilus Parvin, m.d., 
Professor of Obstetrics and Diseases of W^omen and 
Children in Jefferson Medical College. 150 Engrav- 
ings, most of which are original. 
'* The book will be a valuable one to physicians, and a safe and 

satisfactoi-;^' one to put into the hands of students. It is issued in a 

neat and attractive form, and at a very reasonable price." — Boston 

Medical and Surgical Journal . 

No. 3. OBSTETRICS. 227 Illustrations. 

A Manual of Midwifery. By Alfred Lewis Galabin, 
M.A., M.D., Obstetric Physician and Lecturer on Mid- 
wifery and the Diseases of Women at Guy's Hospital, 
London; Examiner in Midwifery to the Conjoint 
Examining Board of England, etc. With 227 Illus. 
" This manual is one we can strongly recommend to all who 
desire to study the science as well as the practice of midwifery. 
Students at the present time not only are expected to know the 
principles of diagnosis, and the treatment of the various emergen- 
cies and complications that occur in the practice of midwifery, but 
find that the tendenc}'^ is for examiners to ask more questions 
relating to the science of the subject than was the custom a few 
years ago. * * * The general standard of the manual is high ; 
and wherever the science and practice of m.idwifery are well taught 
it will be regarded as one of the most important text-books on the 
subject." — London Practitioner. 

No. 4. PKYSIOLOG-^". Fifth Edition. 

321 ILLUSTRATIONS AND A GLOSSARY. 
A Manual of Physiology. By Gerald F. Yeo, m.d., 
F.R.CS., Professor of Physiology in King's College, 
London. 321 Illustradons and a Glossary of Terms. 
Fifth American from last English Edition, revised and 
improved, 758 pages. 

This volume was specially prepared to furnish students with a 
new text-book of Physiology^ elementary so far as to avoid theories 
which have not borne the test of time and such details of methods 
as are unnecessary for students in our medical colleges. 

'*The brief examination I have given ir was so favorable that I 
placed it in the list of text-books recommended in the circular of the 
University Medical College." — Prof. Lewis A. Stiinson, m.d., 
57 Eait ssd Street, Neiv York. 

Price of each Book, Cloth, $3.00; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 5. DISEASES OP CHILDREN. 

SECOND EDITION. 
A Manual. By J. F. Goodhart, m.d., Phys. to the 
Evelina Hospital for Children ; Asst. Phys. to 
Guy's Hospital, London. Second American Edition. 
Edited and Rearranged by Louis Starr, m.d., Clinical 
Prof, of Dis. of Children in the Hospital of the Univ. 
of Pennsylvania, and Physician to the Children's Hos- 
pital, Phila. Containing many new Prescriptions, a list 
of over 50 Formulae, conforming to the U. S. Pharma- 
copoeia, and Directions for making Artificial Human 
Milk, for the Artificial Digestion of Milk, etc. Illus. 

*' The author has avoided the not uncommon error of writing a 
book on general medicine and labehng it ' Diseases of Children,' 
but has steadily kept in view the diseases which seemed to be 
incidental to childhood, or such points in disease as appear to be so 
peculiar to or pronounced in children as to justify insistence upon 
them. * * * A safe and reliable guide, and in many ways 
admirably adapted to the wants of the student and practitioner." — 
American Journal of Medical Science. 

No. 6. MATERIA MEDICA, PHARMACY, 
PHARMAGOLOG-Y, AND THE- 
RAPEUTICS. 

JUST READY. 
A Handbook for Students. By Wm. Hale White, 
M.D.J F.R.C.P., etc.. Physician to, and Lecturer on Ma- 
teria Medica, Guy's Hospital; Examiner in Materia 
Medica, Royal College of Physicians, London, etc. 
American Edition. Revised by Reynold W. Wilcox, 
M.A., M.D., Prof, of CUnical Medicine at the New York 
Post-Graduate Medical School and Hospital ; Assistant 
Visiting Physician Bellevue Hospital. 580 pages. 

In preparing this book, the wants of the medical student of to-day- 
have been constantly kept in view. The division into several sub- 
jects, which are all arranged in a systematic, practical manner, will 
be found of great help in mastering the whole. The work of the 
editor has been mainly in the line of adapting the book to the use 
of American students ; at the same time, however, he has added 
much new material. Dr. Wilcox's long experience in teaching 
and writing on therapeutical subjects particularly fits him for the 
position of editor, and the double authorship has resulted in mak- 
ing a very complete handbook, containing much minor useful in- 
formation that if prepared by one man might have been overlooked. 

Price of each Book, Cloth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 7. MEDICAL JURISPRUDENCE AND 
TOXICOLOQY. 

THIRD REVISED EDITION. 
By John J. Reese, m.d., Professor of Medical Jurispru- 
dence and Toxicology in the University of Pennsyl- 
vania ; President of the Medical Jurisprudence Society 
of Phila. ; Third Edition, Revised and Enlarged. 

*'This admirable text-book." — Avier.Jour. of Med. Sciences. 

" We lay this volume aside, after a careful perusal of its pages, 
with the profound impression that it should be in the hands of every 

doctor and lawyer. It fully meets the wants of all students 

He has succeeded in admirably condensing into a handy volume all 
the essential points." — Cincinnati Lancet and Clinic. 

No. 8. DISEASES' OF THE EYE. 176 Illus. 

FOURTH EDITION. JUST READY. 

Diseases of the Eye and their Treatment. A Handbook 
for Physicians and Students. By Henry R. Swanzy, 
A.M., M.B,, F.R.C.S.I., Surgeon to the National Eye and 
Ear Infirmary ; Ophthalmic Surgeon to the Adelaide 
Hospital, Dublin; Examiner in Ophthalmic Surgery 
in the Royal University of Ireland. Fourth Edition, 
Thoroughly Revised. 176 Illustrations and a Zephyr 
Test Plate. 500 pages. 

" Mr. Swanzy has succeeded in producing the most intellectually 
conceived and thoroughly executed resume of the science within 
the limits he has assigned himself. As a * students* handbook/ 
small in size and moderate in price, it can hardly be equaled." — 
Medical News. 

"A full, clear, and comprehensive statement of Eye Diseases 
and their treatment, practical and thorough, and we feel fully jus- 
tified in commending it to our readers. It is written in a clear and 
forcible style, presenting in a condensed yet comprehensive form 
current and modern information that will prove alike beneficial to 
tlip student and general practitioner." — Southern Practitioner. 

No. 9. MENTAL. DISEASES. 

WITH ILLUSTRATIONS. JUST READY. 

Lectures on Mental Diseases, designed for Medical Stu- 
dents and General Practitioners. By Henry Putnam 
Stearns, a.m.-, m.d.. Physician Superintendent at the 
Hartford Retreat, Lecturer on Mental Diseases in Yale 
University, New Haven, Conn., Hon. Mem. British 
Psycho. Asso'n, etc. With Illustrations and a Digest of 
the Laws of the various States relating to the Commit- 
ment and Care of the Insane. 636 pages. 

Price of each Book, Cloth, $3.00; Leather, $3.50. 



6 STUDENTS' TEXT-BOOKS AND MANUALS. 

ANATOMY. 

Morris' New Text-Book on Anatomy. No7v Ready. By- 
ten leading Surgeons and Anatomists, and Edited by Henry 
Morris, F.R.c.s. 791 Specially Engraved Illustrations, 214 of 
which are printed in colors. Octavo. 1280 pages. 

Price in Cloth, 7.50 ; Sheep, 8.50 ; Half Russia, 9.50. 
*** Send for Descriptive Circular and Sample Pages. 

Macalister's Human Anatomy. 8i5 Illustrations. A new 
Text-book for Students and Practitioners, Systematic and Topo- 
graphical, including the Embryology, Histology, and Morphology 
of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 

Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm, R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations. 
i2mo. Cloth, 1.00; Interleaved for notes, 1.25 

Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. 

Bound in Oilcloth, for the Dissecting^ Room, $4.50. 
»Holden's Hum.an Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the 
Muscles. The General and Microscopical Structure of Bone and 
its Development. With Lithographic Plates and Num.erous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 
Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 
Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. Seepage 14. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

CHEMISTRY. 

Hartley's Medical Chemistry. Second Edition. A text-book 
prepared specially for Medical, Pharmaceutical, and Dental Stu- 
dents. With 50 Illustrations, Plate of Absorption Spectra and 
Glossary of Chemical Terms. Revised and Enlarged. Cloth, 2.50 

Trimble. Practical and Analytical Chemistry. A Course in 
Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- 
istry in the Phila. College of Pharmacy. Illustrated. Fourth 
Edition, Enlarged. 8vo. Cloth, 1.50 

Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
Seventh Edition. 281 Illustrations. Cloth, 4.50; Leather, 5.50 
4S* See pages 2 to ^ /or list of StiidenU* Manuals . 



STUDENTS' TEXT-BOOKS AND MANtlALS. 7 

Chemistry : — Continued. 

Richter's Inorganic Chemistry. Fourth American, from Sixth 
German Edition. Translated by Prof. Edgar F. Smith, ph.d. 
89 Wood Engravings and Colored Plate of Spectra. Cloth, 2.00 

Richter's Organic Chemistry, or Chemistry of the Carbon 
Compounds, Illustrated. Second Edition. Cloth, 4.50 

Symonds. Manual of Chemistry, for the special use of Medi- 
cal Students. By Brandreth Symonds, a.m., m.d., Asst. 
Physician Roosevelt Hospital, Out-Patient Department ; Attend- 
ing Physician Northwestern Dispensarj'', New York. Cloth, 2.00 

LfCffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition. Revised. 
See page i^. Cloth, i. 00; Interleaved for Notes, 1.25 

Lrcffmann and Beam. Progressive Exercises in Practical 
Chemistry. i2mo. Illustrated. • Cloth, i.oo 

Muter. Practical and Analytical Chemistry. Fourth Edi- 
tion. Revised, to meet the requirements of American Medical 
Colleges, by Prof. C. C. Hamilton. Illustrated. Cloth, 2.00 

Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. Fourth 
Edition, Enlarged. Illustrated. Cloth, i.oo 

Van Niiys. Urine Analysis. Illus. Cloth, 2.00 

CHILDREN. 

Goodhart and Starr. The Diseases of Children. Second 
Edition. By J. F. Goodhart, m.d.. Physician to the Evelina 
Hospital for Children; Assistant Physician to Guy's Hospital, 
London. Revised and Edited by Louis Starr, m.d.. Clinical 
Professor of Diseases of Children in the Hospital of the Univer- 
sity of Pennsylvania ; Physician to the Children's Hospital, 
Philadelphia. Containing many Prescriptions and Formulae, 
conforming to the U. S. Pharmacopoeia, Directions for making 
Artificial Human Milk, for the Artificial Digestion of Milk, etc. 
Illustrated. Cloth, 3.00; Leather, 3.50 

Hatfield. Diseases of Children. By M. P. Hatfield, m.d.. 
Professor of Diseases of Children, Chicago Medical College. 
Colored Plate. i2mo. Cloth, i.oo; Interleaved, 1.25 

Starr. Diseases of the Digestive Organs in Infancy and 
Childhood. With chapters on the Investigation of Disease, 
and on the General Management of Children. By Louis Starr, 
M.D., Clinical Professor of Diseases of Children in the Univer- 
sity of Pennsylvania. Illus. Second Edition. Cloth, 2.25 
4^ See pages 14 and 13 for list of ? Quiz- Cotnp ends f 



8 STUD^INTS' TEXT-BOOKS AND MANUALS. 

DENTISTRY. 

Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 

Flagg's Plastics and Plastic Filling. 4th Ed. Cloth, 4.00 
Gorgas. Dental Medicine. Fourth Edition. Cloth, 3.50 

Harris. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery 
and Mechanism. Twelfth Edition. Revised and enlarged by 
Professor Gorgas. 1028 Illustrations. Cloth, 7,00 ; Leather, 8.00 
Richardson's Mechanical Dentistry. Fifth Edition. 569 
Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 

Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 
Taft's Operative Dentistry. Dental Students and Practitioners. 
Fourth Edition. 100 Illustrations. Cloth, 4.25 ; Leather, 5.00 
Talbot. Irregularities of the Teeth, and their Treatment. 
Illustrated. 8vo. Second Edition. Cloth, 3.00 

Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. 292 Illus. Cloth, 5.00 
Warren. Compend of Dental Pathology and Dental Medi- 
cine. Illustrated. 2d Ed. Cloth, i. 00; Interleaved, 1.25 

DICTIONARIES. 

Gould's New Medical Dictionary, Containing the Definition 
and Pronunciation of all words in Medicine, with many useful 
Tables etc. J4 Dark Leather, 3.25 ; ^ Mor., Thumb Index, 4.25 

Gould's Pocket Dictionary. 12,000 Medical Words Pro- 
nounced and Defined. Containing many Tables and an 
Elaborate Dose List. Thin 64mo. Just Ready. Leather, i.oo 

Harris' Dictionary of Dentistry. Fifth Edition. Completely 
revised by Prof. Gorgas. Cloth, 5.00; Leather, 6.00 

Cleaveland's Pronouncing Pocket Medical Lexicon. Small 
pocket size. Cloth, red edges .75 ; pocket-book style, i.oo 

Longley's Pocket Dictionary. The Student's Medical Lexicon, 
giving Definition and Pronunciation , with an Appendix giving 
Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 
24mo. Cloth, 1,00; pocket-book style, 1.25 

EYE. 

Hartridge on Refraction. 5th Edition. Illus. Cloth, 2.00 

Swanzy. Diseases of the Eye and their Treatment. 176 

Illustrations. Fourth Edition. Cloth, 3 00; Leather, 3.50 

Fox and Gould. Compend of Diseases of the Eye and 

Refraction. 2d Ed. Enlarged. 71 Illus. 39 Formulse. 

Cloth, I.oo ; Interleaved for Notes, 1.25 
SS^ See pages 2 to $ for list of Students' Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 9 

ELECTRICITY. 

Bigelow. Plain Talks on Medical Electricity. Cloth, i.oo 

Mason's Compend of Medical Electricity. Cloth, i.oo 

Steavenson and Jones. Medical Electricity. A Practical 

Handbook. Just Ready. Illustrated. i2mo. Cloth, 2.50 

HYGIENE. 

Coplin and Bevan. Practical Hygiene. By \V. M. L. Cop- 
lin. Adjunct Professor of Hygiene, Jefferson Medical College, 
Philadelphia, and Dr. D. Bevan. Illustrated. In Press, 

Parkes' (Ed. A.) Practical Hygiene, Seventh Edition, en- 
larged. Illustrated. 8vo. Cloth, 4.50 

Parkes* (L. C.) Manual of Hygiene and Public Health. 
Second Edition. i2mo. Cloth, 2.50 

Wilson's Handbook of Hygiene and Sanitary Science. 
Seventh Edition. Revised and Illustrated. Cloth, 3.25 

MATERIA MEDICA AND THERAPEUTICS. 

Potter's Compend of Materia Medica, Therapeutics, and 
Prescription Writing. Fifth Edition, revised and improved. 
Seepage i^. Cloth, i.oo; Interleaved for Notes, 1.25 

Davis. Essentials of Materia Medica and Prescription 
Writing. By J. Aubrey Davis, m.d., Demonstrator of Obstet- 
rics and Quiz-Master on Materia Medica, University of Penn- 
sylvania. i2mo. Interleaved. Nety 1.50 

Biddle's Materia Medica. Twelfth Edition. By the late 
John B. Biddle, m.d. Revised by Clement Biddle, m.d. 8vo. 
Illustrated. Cloth, 4.25; Leather, 5.00 

Potter. Handbook of Materia Medica, Pharmacy, and 
Therapeutics. Including Action of Medicines, Special Thera- 
peutics, Pharmacology, etc. By Saml. O. L. Potter, m.d., 
M.R.c.P. (Lond.), Professor of the Practice of Medicine in 
Cooper Medical College, San Francisco. Fourth Revised and 
Enlarged Edition. 776 pages. 8vo. Cloth, 4.00; Leather, 5.00 

White and Wilcox. Materia Medica, Pharmacy, Phar- 
macology, and Therapeutics. A Handbook for Students. 
By Wm. Hale White, m.d., f.r.c.p., etc., Physician to and 
Lecturer on Materia Medica, Guy's Hospital. Revised by 
Reynold W. Wilcox, m.d.. Professor of Clinical Medicine at the 
New York Post Graduate Medical School, Assistant Physician 
Bellevue Hospital, etc. American Edition. Clo., 3.00; Lea., 3.50 
M^' See pages 14 and /j for list of ? Quiz- Compends ? 



10 STUDENTS' TEXT-BOOKS AND MANUALS. 



MEDICAL JURISPRUDENCE. 

Reese. A Text-book of Medical Jurisprudence and Toxi- 
cology. By John J. Reese, m.d.. Professor of Medical Juris- 
prudence and Toxicology in the Medical Department of the 
University of Pennsylvania ; Physician to St. Joseph's Hospital. 
Third Edition. Cloth, 3.00; Leather, 3.50 

NERVOUS DISEASES. 

Gowers. Manual of Diseases of the Nervous System. 
A Complete Text-book. By William R. Gowers, m.d.. Prof. 
Clinical Medicine, University College, London. Physician to 
National Hospital for the Paralyzed and Epileptic. Second 
Edition. Revised, Enlarged, and in many parts Rewritten. 
With many new Illustrations. Octavo. 

Vol. I. Diseases of the Nerves and Spinal Cord. 616 

' pages. Cloth, 3.50 

Vol. II. Diseases of the Brain and Cranial Nerves. 
General and Functional Diseases. Nearly Ready, 

Ormerod. Diseases of Nervous System, Student's Guide to. 
By J. A. Ormerod, m.d., Oxon.,F.R.c.p. (London), Member Path- 
ological, Clinical, Ophthalmological, and Neurological Societies, 
Physician to National Hospital for Paralyzed and Epileptic and 
to City of London Hospital for Diseases of the Chest, Demon- 
strator of Morbid Anatomy, St. Bartholomew's Hospital, etc. 
With 75 Wood Engravings. Cloth, 2.00 

OBSTETRICS AND GYNECOLOGY. 

Davis. A Manual of Obstetrics. By Edw. P. Davis, Clinical 
Lecturer on Obstetrics, Jefferson Medical College, Philadelphia, 
Colored Plates, and 130 other Illustrations. i2mo. Cloth, 2.00 

Byford. Diseases of Women. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to 
Women. By W. H. Byford, a.m., m.d.. Professor of Gynaecology 
in Rush Medical College and of Obstetrics in the Woman's Med- 
ical College, etc., and Henry T. Byford, m.d.. Surgeon to the 
Woman's Hospital of Chicago. Fourth Edition. Revised and 
Enlarged. 306 Illustrations, over 100 of which are original. 
Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 

Lewers' Diseases of "Women. A Practical Text-book. 139 

Illustrations. Second Edition. Cloth, 2.50 

Parvin's Winckel's Diseases of Women. Second Edition. 

Including a Section on Diseases of the Bladder and Urethra. 
150 lUus. Revised. Seepages. Cloth, 3.00; Leather, 3.50 

Morris. Compend of Gynsecology. Illustrated. Cloth, i.oo 

Winckel's Obstetrics. A Text-book on Midwifery, includ- 
ing the Diseases of Childbed. By Dr. F. Winckel, Professor 
of Gynsecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J. Chfton 
Edgar, m.d., Lecturer on Obstetrics, University Medical Col- 
lege, New York, with nearly 200 handsome Illustrations, the 
majority of which are original. 8vo. Cloth, 6.00; Leather, 7.00 

4^ See pa^es 2 to sfor Ust o/Neiv Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 11 

Obstetrics and GyncECoIogy : — Continued. 
Landis' Compend of Obstetrics. Illustrated. 4th Edition, 
Enlarged. Cloth, i.oo; Interleaved for Notes, 1.25 

Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p. 

227 Illustrations. See page 3. Cloth, 3.00; Leather, 3.50 

PATHOLOGY, HISTOLOGY, ETC. 

Wethered. Medical Microscopy. By Frank J. Wethered, 
M.D., M.R.c.P. 98 Illustrations. Cloth, 2.50 

Bowlby. Surgical Pathology and Morbid Anatomy, for 
Students. 135 Illustrations. i2mo. Cloth, 2.00 

Gilliam's Essentials of Pathology. A Handbook for Students. 
47 Illustrations. i2mo. Cloth, 2.00 

Virchow's Post-Mortem Examinations. 3d Ed. Cloth, i.oo 

PHYSICAL DIAGNOSIS. 

Fenwick. Student's Guide to Physical Diagnosis. 7th 
Edition. 117 Illustrations. lamo. Cloth, 2.25 

Tyson's Student's Handbook of Physical Diagnosis. Illus- 
trated. i2mo. Cloth, 1.25 

PHYSIOLOGY. 

Yeo's Physiology. Fifth Edition. The most Popular Stu- 
dents' Book. By Gerald F. Yeo, m.d., f.r.c.s.. Professor of 
Physiology in King's College, London. Small Octavo. 758 
pages. 321 carefully printed Illustrations. With a Full 
Glossary and Index. Seepages. Cloth, 3.00; Leather, 3.50 

Brubaker's Compend of Physiology. Illustrated. Sixth 
Edition. Cloth, i.oo; Interleaved for Notes, 1.25 

Kirke's Physiology. New 13th Ed. Thoroughly Revised and 
Enlarged. 502 Illustrations, some of which are printed in colors. 

, {Blakiston^s Atcthorized Edition,) Cloth, 4.00; Leather, 5.00 

Landois' Human Physiology. Including Histology and Micro- 
scopical Anatomy, and with special reference to Practical Medi- 
cine. Fourth Edition. Translated and Edited by Prof. Stirling. 
845 Illustrations. Cloth, 7.00; Leather, 8.00 

" With this Text-book at his command, no student could fail in 

his examination." — Lancet. 

Sanderson's Physiological Laboratory. Being Practical Ex- 
ercises for the Student. 350 Illustrations. Bvo. Cloth, 5.00 

PRACTICE. 

Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
Hospital, London ; Physician to Evelina Hospital for Sick Chil- 
dren, and Examiner in Materia Medica and Pharmaceutical 
Chemistry, University of London. Cloth, 2.00; Leather, 2.50 

4^ See pages 14 and IS fo^ ^i^i 0/ ? Quiz-Compends f 



12 STUDENTS' TEXT-BOOKS AND MANUALS. 

Practice : — Continued. 

Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d., m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50 ; Sheep, 6.50 

Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, i.oo; Interleaved for Notes, 1.25 
Part i. — Continued, Eruptive and Periodical Fevers, Diseases 

of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 

Kidneys, etc., and General Diseases, etc. 

Part ii. — Diseases of the Respiratory System, Circulatory 

System, and Nervous System ; Diseases of the Blood, etc. 

Physicians' Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index,, i vol. Full Morocco, Gilt, 2,50 

From. John A. Robinson, M.D. , Assistant to Chair of Clinical 
Medicine ^noiu Lecturer on Materia Medica, Rush Medical Col- 
lege, Chicago. 
*' Meets with my hearty approbation as a substitute for the 

ordinary note books almost universally used by medical students. 

It is concise, accurate, well arranged, and lucid, . . . just the 

thing for students to use while studying physical diagnosis and the 

more practical departments of medicine.*' 

PRESCRIPTION BOOKS. 

Wythe's Dose and Symptom Book. Containing the Doses 
and Uses of all the principal Articles of the Materia Medica, etc. 
Seventeenth Edition. Completely Revised and Rewritten. Just 
Ready. 32mo. Cloth, i. 00; Pocket-book style, 1.25 

Pereira's Physician's Prescription Book. Containing Lists 
of Terms, Phrases, Contractions, and Abbreviations used in 
Prescriptions, Explanatory Notes, Grammatical Construction ot 
Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. 
Sixteenth Edition. 32mo. Cloth, i. 00; Pocket-book style, 1.25 

PHARMACY. 

Stewart's Compend of Pharmacy. Based upon Remington's 
Text-book of Pharmacy. Third- Edition, Revised. With new 
Tables, Index, Etc, Cloth., i.oo ; Interleaved for Notes, 1.25 

Robinson. Latin Grammar of Pharmacy and Medicine. 
By H. D. Robinson, ph.d.. Professor of Latin Language and 
Literature, University of Kansas, Lawrence. With an Intro- 
duction by L. E. Sayre, ph.g.. Professor of Pharmacy in, and 
Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. 

Cloth, 2,00 

SKIN DISEASES. 

Crocker. Diseases of the Skin, their Description, Pathology, 
Diagnosis, and Treatment, with Special Reference to the Skin 
Eruptions of Children. By H. RadcliiFe Crocker, f.r.c.p., Phy- • 
sician for Diseases of the Skin in University College Hospital. 
Second Edition. Revised and Enlarged, with 92 Wood-cuts. 

Cloth, 5.00 

Van Harlingen on Skin Diseases. A Handbook of the Dis- 
eases of the Skin. By Arthur Van Harlingen, m.d. 2d Edition. 
Enlarged. i2mo. Cloth, 2.50 

4^^ See pages 2 to 5 for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 13 
SURGERY AND BANDAGING. 

Moullin's Surgery. 500 Illustrations (some colored), 200 of 
which are original. • 2d Ed. Cloth, net 7.00; Leather, net 8.00 

Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students, and Hospital Surgeons. By W, H. A. 
Jacobson, b.a. Oxon., f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- 
pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 

Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 

Horwitz's Compend of Surgery, Minor Surgery and 
Bandaging, Amputations, Fractures, Dislocations, Surgical 
Diseases, and the Latest Antiseptic Rules, etc., with Differential 
Diagnosis and Treatment. By Orville Horwitz, b.s., m.d.. 
Demonstrator of Surgery, Jefferson Medical College. 5th Edition, 
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*:J:*The new Section on Bandaging and Surgical Dressings con- 
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importance is figured. This, with the Section on Ligation of 
Arteries, forms an ample Text-book for the Surgical Laboratory. 

Walsham. Manual of Practical Surgery. Third Edition. 
By Wm. J. Walsham, m.d., f.r.c.s., Asst, Surg, to, and Dem- 
of Practical Surg, in, St. Bartholomew's Hospital; Surgeon to 
Metropolitan Free Hospital, London. With 318 Engravings. 
See page 2. Cloth, 3.00; Leather, 3.50 

URINE, URINARY ORGANS, ETC. 

Holland. The Urine, and Common Poisons and The 
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trated. Fourth Edition. i2mo. Interleaved. Cloth, i.oo 

Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- 
trations. i2mo. 572 pages. Cloth, 2.75 

Marshall and Smith. On the Urine. The Chemical Analysis ot 
the Urine. By John Marshall, m.d.. Chemical Laboratory, Univ. 
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Memminger. Diagnosis by the Urine. Illustrated, 

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Van Niiys, Urine Analysis. Illus. Cloth, 2.00 

VENEREAL DISEASES. 

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4®* See pages 14 and /j for list 0/ f Quiz-Compends f 



? 



QUIZ-COMPENDS? 

The Best Compends for Students' Use 
in the Quiz Class, and when Pre- 
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Compiled in accordance with the latest teachings of promi- 
nent Lecttirers and the most popular Text- books. 

They form a most complete, practical, and exhaustive 
set of manuals, containing information nowhere else col- 
lected in such a condensed, practical shape. Thoroughly 
up to the times in erery respect, containing many new 
prescriptions and formulae, and over two hundred and 
fifty illustrations, many of which have been drawn and 
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large experience as quiz-masters and attaches of colleges, 
with exceptional opportunities for noting the most recent 
advances and methods. 

Cloth, each $i.cx). Interleaved for Notes, $1.25. 
No. I. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New 
Tables, and 117 other Illustrations. By Samuel O. L. 
Potter, m.a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon U. S. 
Army, Professor of Practice, Cooper Medical College, San Fran- 
cisco. 
Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 
Part I. — Continued, Eruptive, and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Phy- 
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eases of the Blood, etc. # 

*^* These little hooks can be regarded as a full set of notes upon 
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lished. 

No. 4. PHYSIOLOGY, including Embryology. Sixth 
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Penn'a College of Dental Surgery ; Demonstrator of Physiology 
in Jefferson Medical College, Philadelphia. Revised, Enlarged, 
with new Illustrations. 

No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
Henry G. Landis, m.d.. Prof, of Obstetrics and Diseases of 
Women in Starling Medical College, Columbus, O. Revised 
Edition. New Illustrations. 



BLAKISTON'S ? QUIZ-COMPENDS ? 

No. 6. MATERIA MEDICA, THERAPEUTICS, AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 

With especial Reference to the Physiological Action of Drugs, 
and a complete article on Prescription Writing. Based on the 
Last Revision of the U. S. Pharmacopoeia, and including man}'- 
unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., 
M.R.c.P. (Lond.), late A, A. Surg. U. S. Army; Prof, of Practice, 
Cooper Medical College, San Francisco. Improved and Enlarged, 
with Index. 
No. 7. GYN/ECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Ob- te tries, Jefferson 
Medical College, Philadelphia. 45 Illustrations. 

No. 8. DISEASES OF THE EYE AND REFRACTION, 

including Treatment and Surgery. By L. Webster Fox, m.d.. 
Chief Chnical Assistant Ophthalmologicai Dept., Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulae. Second Enlarged and Improved Edition. Index. 

No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
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mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College, Revised 
and Enlarged. 84 Formulas and 136 Illustrations. 

No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry'- in 
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and Rewritten, with Index. 

No. II. PHARMACY. Based upon " Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph.g. , Quiz-Master 
at Philadelphia College of Pharmacy. Third Edition, Revised. 

No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R. Ballou, m.d.. Prof, of 
Equine Anatomy at N Y. College of Veterinary Surgeons. 

No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. Second Edition. By Geo. W. Warren, 
D.D.S., Clinical Chief, Penn'a College of Dental Surgery, Phila- 
delphia. Illustrated. 

No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Colored Plate. 

Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 

J|@* These books a7'e constantly revised to keep up with 
the latest teachings and discoveries, so that they contain 
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notes upon the subject tinder consideration. 

Illustrated Descriptive Circular Free. 



GOULD'S NEW 

Medical Dictionary. 

Based on Eecent Medical Literature. 



Small 8vo, Half Morocco, as above, with Thumb Index, . . ^4.25 
Plain Dark Leather, without Thumb Index, . * 3.25. 



A compact, concise Vocabulary, including all 
the Words and Phrases used in medicine, with 
their proper Pronunciation and Definitions. 



**One pleasing feature of the book is that the reader can almost 
invariably find the definition under the word he looks for, without 
being referred from one place to another, as is too commonly the 
case in medical dictionaries. The tables of the bacilli, micrococci, 
leucomaines and ptoma'mes are excellent, and contain a large 
amount of information in a limited space. The anatomical tables 
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Science. 

JUST PUBLISHED. 
GOULD'S POCKET DICTIONARY. 12,000 
Medical Words Pronounced and l)efined. 

Cloth, $1.00; Leather, ^1.25 



